Provider Demographics
NPI:1548214661
Name:EDWARDS, ROSE M (LCSW-C)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 HOLLEN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2718
Mailing Address - Country:US
Mailing Address - Phone:410-350-4183
Mailing Address - Fax:
Practice Address - Street 1:2360 W. JOPPA RD.
Practice Address - Street 2:STE 229
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:443-900-7145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD060381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD377321300Medicaid
K522M375Medicare ID - Type Unspecified