Provider Demographics
NPI:1457844003
Name:EDWARDS, CALLAN JEAN (MSW)
Entity Type:Individual
Prefix:
First Name:CALLAN
Middle Name:JEAN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 W SUNSET BLVD # 38
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6020
Mailing Address - Country:US
Mailing Address - Phone:323-361-2485
Mailing Address - Fax:
Practice Address - Street 1:4601 W SUNSET BLVD # 38
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6020
Practice Address - Country:US
Practice Address - Phone:323-361-2485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA926321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program