Provider Demographics
NPI:1609855170
Name:EDWARDS, MARTIN R (PHD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:R
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2745
Mailing Address - Country:US
Mailing Address - Phone:319-277-4383
Mailing Address - Fax:319-268-2207
Practice Address - Street 1:324 W 3RD ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2745
Practice Address - Country:US
Practice Address - Phone:319-277-4383
Practice Address - Fax:319-268-2207
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0001101YM0800X
IA0005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health