Healthcare Provider Details

I. General information

NPI: 1386717031
Provider Name (Legal Business Name): EDWARD SWEENEY REDMOND LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COUNTRY CLUB RD VILLAGE WEST I STE 405
GILFORD NH
03247
US

IV. Provider business mailing address

PO BOX 7198 25 COUNTRY CLUB RD VILLAGE WEST I STE 405
GILFORD NH
03247
US

V. Phone/Fax

Practice location:
  • Phone: 603-293-0395
  • Fax: 603-293-0395
Mailing address:
  • Phone: 603-293-0395
  • Fax: 603-293-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number374
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: