Provider Demographics
NPI:1346826765
Name:EDWARDS, NEELAM THERESE
Entity Type:Individual
Prefix:
First Name:NEELAM
Middle Name:THERESE
Last Name:EDWARDS
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 1:1450 N LAKE AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2388
Mailing Address - Country:US
Mailing Address - Phone:310-854-2202
Mailing Address - Fax:626-794-6071
Practice Address - Street 1:1450 N LAKE AVE STE 150
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2388
Practice Address - Country:US
Practice Address - Phone:310-854-2202
Practice Address - Fax:626-794-6071
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)