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NPI Code Detail

MEDICARE: JENNIFER L EDGE LICSW

MEDICARE: JENNIFER L EDGE LICSW
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 WorkerISW02865RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1146467OTHERVAANTHEM BCBS

General Provider Information

NPI Number : 1497825889
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER L EDGE LICSW
Provider Business Mailing Address
First Line : 1090 CRANSTON ST
Second Line :
City : CRANSTON
State : RI
Zip : 02920-7323
Country : US
Telephone Number : 401-467-9610
Fax Number : 401-223-0121
Provider Business Practice Location Address
First Line : 1090 CRANSTON ST
Second Line :
City : CRANSTON
State : RI
Zip : 02920-7323
Country : US
Telephone Number : 401-467-9610
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 12/31/2020

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Directions to “ JENNIFER L EDGE LICSW” Practice Location

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