Provider Demographics
NPI:1427379585
Name:EDWARDS, SANJAE E (LCSW)
Entity Type:Individual
Prefix:
First Name:SANJAE
Middle Name:E
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4161 CARMICHAEL AVE
Mailing Address - Street 2:140
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-2353
Mailing Address - Country:US
Mailing Address - Phone:904-527-3300
Mailing Address - Fax:
Practice Address - Street 1:4161 CARMICHAEL AVE
Practice Address - Street 2:140
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-2353
Practice Address - Country:US
Practice Address - Phone:904-527-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW94861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical