Provider Demographics
NPI:1417691833
Name:EDWARDS, MAUREEN RENA (LSW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:RENA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:R
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:506 W MOUNT PLEASANT AVE # 1138
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1701
Mailing Address - Country:US
Mailing Address - Phone:862-234-0343
Mailing Address - Fax:
Practice Address - Street 1:25 MANOR DR APT 7N
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-3260
Practice Address - Country:US
Practice Address - Phone:201-250-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC061472001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty