Healthcare Provider Details

I. General information

NPI: 1932319795
Provider Name (Legal Business Name): ROBERT L. EDWARDS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19291 NORTHLINE RD
SOUTHGATE MI
48195-2220
US

IV. Provider business mailing address

17315 FITZGERALD ST
LIVONIA MI
48152-2709
US

V. Phone/Fax

Practice location:
  • Phone: 734-287-1500
  • Fax: 734-287-1660
Mailing address:
  • Phone: 734-732-2185
  • Fax: 734-953-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801007841
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: