Provider Demographics
NPI:1346896040
Name:EDWARDS, WARNE (MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:WARNE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DENNISON
Mailing Address - State:OH
Mailing Address - Zip Code:44621-1216
Mailing Address - Country:US
Mailing Address - Phone:330-260-0012
Mailing Address - Fax:
Practice Address - Street 1:204 GRANT ST
Practice Address - Street 2:
Practice Address - City:DENNISON
Practice Address - State:OH
Practice Address - Zip Code:44621-1216
Practice Address - Country:US
Practice Address - Phone:330-260-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0800231-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker