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General NPI Number Information
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NPI Number | 1366986812
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Entity Type | Organization
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Legal Business Name | EDWARDS MENTORING AND SOCIAL SERVICES, LMSW, P.L.L.C.
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 19005 122ND AVE SUITE A
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City | SPRINGFIELD GARDENS
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State | NY
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Zip | 11413-1010
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Country | US
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Telephone | 646-824-5737
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Fax |
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Provider Business Mailing Address
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Address Line | 19005 122ND AVE SUITE A
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City | SPRINGFIELD GARDENS
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State | NY
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Zip | 11413-1010
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Country | US
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Telephone | 646-824-5737
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Fax |
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Authorized Official
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Title or Position | FOUNDER / DIRECTOR
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Name | MR. LARRY D EDWARDS
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Credential | LMSW
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Telephone | 646-824-5737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 092982
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 092982
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 092982
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 092982
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License Number State | NY
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