Provider Demographics
NPI:1114607348
Name:EDWARDS, JUSTINA (MSW)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 E 94TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1105
Mailing Address - Country:US
Mailing Address - Phone:929-351-2915
Mailing Address - Fax:
Practice Address - Street 1:3704 91ST ST FL 2
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7914
Practice Address - Country:US
Practice Address - Phone:347-730-4249
Practice Address - Fax:347-730-4216
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker