Provider Demographics
NPI:1528391786
Name:EDWARDS, STANLEY B
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:B
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-3926
Mailing Address - Country:US
Mailing Address - Phone:415-864-3057
Mailing Address - Fax:415-864-3163
Practice Address - Street 1:1175 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3926
Practice Address - Country:US
Practice Address - Phone:415-864-3057
Practice Address - Fax:415-864-3163
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)