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NPI Code Detail

MEDICARE: MR. SAM EDWARDS JR. LCSW

MEDICARE: MR. SAM EDWARDS JR. LCSW
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
11041C0700XClinical Social WorkerLCS3478CA

General Provider Information

NPI Number : 1215010517
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SAM EDWARDS JR. LCSW
Provider Business Mailing Address
First Line : 1721 SCOTT ST
Second Line : SUITE, #C
City : SAN FRANCISCO
State : CA
Zip : 94115-3035
Country : US
Telephone Number : 415-563-4316
Fax Number : 415-242-4179
Provider Business Practice Location Address
First Line : 1721 SCOTT ST
Second Line : SUITE, #C
City : SAN FRANCISCO
State : CA
Zip : 94115-3035
Country : US
Telephone Number : 415-563-4316
Fax Number : 415-242-4179
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 07/08/2007

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