Healthcare Provider Details

I. General information

NPI: 1831003888
Provider Name (Legal Business Name): REBECCA EDWARDS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 OSWEGO ST
UTICA NY
13502-5031
US

IV. Provider business mailing address

1621 GENESEE ST APT 2
UTICA NY
13501-4749
US

V. Phone/Fax

Practice location:
  • Phone: 315-798-8868
  • Fax:
Mailing address:
  • Phone: 315-264-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number133704
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: