Provider Demographics
NPI:1083911473
Name:EDWARDS, IAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6857
Mailing Address - Country:US
Mailing Address - Phone:724-679-0747
Mailing Address - Fax:724-287-3779
Practice Address - Street 1:350 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4921
Practice Address - Country:US
Practice Address - Phone:724-679-0747
Practice Address - Fax:724-287-3779
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016589103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist