Healthcare Provider Details

I. General information

NPI: 1114427424
Provider Name (Legal Business Name): ROBERT JOSEPH EDWARDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 FLORIDA AVE
SAINT CLOUD FL
34769-3721
US

IV. Provider business mailing address

1086 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-2031
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-7620
  • Fax:
Mailing address:
  • Phone: 407-448-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16105
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: