Healthcare Provider Details

I. General information

NPI: 1972076230
Provider Name (Legal Business Name): EDWARD ATWOOD LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 VETERANS AVE
BATH NY
14810-0810
US

IV. Provider business mailing address

76 VETERANS AVE
BATH NY
14810-0810
US

V. Phone/Fax

Practice location:
  • Phone: 607-664-4319
  • Fax: 607-664-4360
Mailing address:
  • Phone: 607-438-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number098750-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: