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General NPI Number Information
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NPI Number | 1073004206
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Entity Type | Individual
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Provider Name | EDGAR ANTHONY TSAMASIROS BSW LISCENSED SOCAIL
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Gender | Male
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 732 BECKMAN ST
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City | DAYTON
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State | OH
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Zip | 45410-2165
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Country | US
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Telephone | 937-253-1680
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MAPLE GARDENS DR
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City | UNION
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State | OH
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Zip | 45322-3235
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Country | US
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Telephone | 937-718-3091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1802338
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License Number State | OH
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