Provider Demographics
NPI:1215010517
Name:EDWARDS, SAM JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 SCOTT ST
Mailing Address - Street 2:SUITE, #C
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3035
Mailing Address - Country:US
Mailing Address - Phone:415-563-4316
Mailing Address - Fax:415-242-4179
Practice Address - Street 1:1721 SCOTT ST
Practice Address - Street 2:SUITE, #C
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3035
Practice Address - Country:US
Practice Address - Phone:415-563-4316
Practice Address - Fax:415-242-4179
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS34781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical