Healthcare Provider Details

I. General information

NPI: 1700699956
Provider Name (Legal Business Name): MARIA EDMONDSON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 MOUNT VERNON AVE
COLUMBUS OH
43203-1523
US

IV. Provider business mailing address

4415 EUCLID AVE STE 335
CLEVELAND OH
44103-3758
US

V. Phone/Fax

Practice location:
  • Phone: 216-400-0207
  • Fax:
Mailing address:
  • Phone: 216-400-0207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2511765
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: