Provider Demographics
NPI:1417075094
Name:EDWARDS, CURTIS JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:JAY
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3766 CALLE MAZATLAN
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1949
Mailing Address - Country:US
Mailing Address - Phone:805-208-1373
Mailing Address - Fax:
Practice Address - Street 1:3766 CALLE MAZATLAN
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-5044
Practice Address - Country:US
Practice Address - Phone:805-208-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical