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General NPI Number Information
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NPI Number | 1821163791
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Entity Type | Individual
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Provider Name | EDMOND ANDERS MORTENSEN L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 11/23/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 5500 MING AVE SUITE 130
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City | BAKERSFIELD
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State | CA
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Zip | 93309-4689
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Country | US
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Telephone | 661-832-2700
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Fax | 661-832-2772
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Provider Business Mailing Address
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Address Line | 1901 SULLY CT
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City | BAKERSFIELD
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State | CA
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Zip | 93311-1504
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Country | US
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Telephone | 661-664-0436
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Fax | 661-832-2772
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS5177
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License Number State | CA
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