Provider Demographics
NPI:1508039959
Name:EDWARDS, ALETA R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALETA
Middle Name:R
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8928 SOUTHBAY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2770
Mailing Address - Country:US
Mailing Address - Phone:334-717-3155
Mailing Address - Fax:
Practice Address - Street 1:8928 SOUTHBAY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2770
Practice Address - Country:US
Practice Address - Phone:334-717-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004760103TC0700X
FLPY8371103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL530AMedicare PIN