Provider Demographics
NPI:1366508582
Name:EDWARDS, ALLISON DENISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:DENISE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16261 RIVER BEND CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21795-2155
Mailing Address - Country:US
Mailing Address - Phone:301-223-7863
Mailing Address - Fax:
Practice Address - Street 1:16261 RIVER BEND CT
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:MD
Practice Address - Zip Code:21795-2155
Practice Address - Country:US
Practice Address - Phone:301-223-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007722103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV73771Medicare ID - Type Unspecified