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General NPI Number Information
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NPI Number | 1710124839
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Entity Type | Individual
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Provider Name | BRAD DAVID EDWARDS MSW
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Gender | Male
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 3150 HOOMUA DR
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City | KIHEI
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State | HI
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Zip | 96753-9443
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Country | US
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Telephone | 808-250-7929
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Fax |
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Provider Business Mailing Address
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Address Line | 3150 HOOMUA DR
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City | KIHEI
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State | HI
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Zip | 96753-9443
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Country | US
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Telephone | 808-250-7929
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | ASW #17554
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3896
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License Number State | HI
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