Provider Demographics
NPI:1124595194
Name:EDMONDS, CAROLYN MAE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MAE
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 JEWETT PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2322
Mailing Address - Country:US
Mailing Address - Phone:716-533-4300
Mailing Address - Fax:716-533-4301
Practice Address - Street 1:70 JEWETT PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2322
Practice Address - Country:US
Practice Address - Phone:716-533-4300
Practice Address - Fax:716-533-4301
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker