MEDICARE: KELLY EDWARDS-BARRON 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	149.009015	IL

General Provider Information

NPI Number	:	1538268107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY EDWARDS-BARRON LCSW

Provider Business Mailing Address
First Line	:	400 N STEPHANIE ST STE 180
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-6692
Country	:	US
Telephone Number	:	702-791-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N STEPHANIE ST STE 180
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-6692
Country	:	US
Telephone Number	:	702-791-9100
Fax Number	:

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	02/03/2016

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