Healthcare Provider Details

I. General information

NPI: 1720498322
Provider Name (Legal Business Name): BRENDA BEDWARD LSW,LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SOUTHARD ST
TRENTON NJ
08609-1020
US

IV. Provider business mailing address

10 SOUTHARD ST
TRENTON NJ
08609-1020
US

V. Phone/Fax

Practice location:
  • Phone: 609-984-9042
  • Fax: 609-599-1708
Mailing address:
  • Phone: 609-984-9042
  • Fax: 609-599-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number44SL05693600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: