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NPI Code Detail

MEDICARE: ANTWANETTE ELIZABETH EDWARDS

MEDICARE: ANTWANETTE ELIZABETH EDWARDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YM0800XMental Health Counselor
3171M00000XCase Manager/Care Coordinator
4390200000XStudent in an Organized Health Care Education/Training Program
5104100000XSocial Worker

General Provider Information

NPI Number : 1124785134
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTWANETTE ELIZABETH EDWARDS
Provider Business Mailing Address
First Line : 136 VALDIVIA CIR
Second Line :
City : SAN RAMON
State : CA
Zip : 94583-2228
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2387 LISA LN
Second Line :
City : PLEASANT HILL
State : CA
Zip : 94523-3949
Country : US
Telephone Number : 925-677-7480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2021
Last Update Date : 01/06/2025

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