MEDICARE: LUANN M EDWARDS 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
1	106H00000X	Marriage & Family Therapist	MT1070	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4421785	OTHER	FL	AETNA
2	Z3413	OTHER	FL	BC/BS

General Provider Information

NPI Number	:	1225051832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUANN M EDWARDS LCSW

Provider Business Mailing Address
First Line	:	3810-3 WILLIAMSBURG PARK BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-9220
Country	:	US
Telephone Number	:	904-419-6102
Fax Number	:	904-739-2153

Provider Business Practice Location Address
First Line	:	3810-3 WILLIAMSBURG PARK BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-9220
Country	:	US
Telephone Number	:	904-419-6102
Fax Number	:	904-739-2153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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Directions to “ LUANN M EDWARDS LCSW” Practice Location

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