MEDICARE: BARBARA ANN EDELHAUSER 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	1041C0700X	Clinical Social Worker	44SC05849100	NJ

General Provider Information

NPI Number	:	1346756251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA ANN EDELHAUSER LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1960
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08754-1960
Country	:	US
Telephone Number	:	732-966-5195
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 MAIN ST BLDG C
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-7402
Country	:	US
Telephone Number	:	732-503-9253
Fax Number	:

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

Provider Enumeration Date	:	12/15/2017
Last Update Date	:	08/13/2020

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