Provider Demographics
NPI:1447565510
Name:HASKINS, EDWARD ALAN (LSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ALAN
Last Name:HASKINS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2815
Mailing Address - Country:US
Mailing Address - Phone:937-562-4014
Mailing Address - Fax:937-562-4010
Practice Address - Street 1:2100 GREENE WAY BLVD
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2677
Practice Address - Country:US
Practice Address - Phone:937-562-4014
Practice Address - Fax:937-562-4010
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS - 0025934104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker