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General NPI Number Information
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NPI Number | 1992807457
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Entity Type | Individual
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Provider Name | VINCENT JOHN EDWARDS LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/03/2006
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | 36 CHURCH ST
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City | PUTNAM
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State | CT
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Zip | 06260-1866
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Country | US
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Telephone | 860-792-6099
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Fax | 860-792-6099
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Provider Business Mailing Address
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Address Line | 549 TAFT POND RD
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City | POMFRET CENTER
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State | CT
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Zip | 06259-1315
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Country | US
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Telephone | 860-933-8597
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 005418
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License Number State | CT
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