Provider Demographics
NPI:1518496512
Name:EDWARDS CLINICAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:EDWARDS CLINICAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANK-EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:724-224-2500
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:AVONMORE
Mailing Address - State:PA
Mailing Address - Zip Code:15618-0351
Mailing Address - Country:US
Mailing Address - Phone:724-882-7156
Mailing Address - Fax:724-224-2500
Practice Address - Street 1:2858 FREEPORT RD STE B
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1970
Practice Address - Country:US
Practice Address - Phone:724-224-2500
Practice Address - Fax:724-224-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty