Provider Demographics
NPI:1609939131
Name:HELM, EDWARD NELSON (LICSW)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:NELSON
Last Name:HELM
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BRIGHAM CIR
Mailing Address - Street 2:C/O PRIORITY MEDICAL BILLING
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-9240
Mailing Address - Country:US
Mailing Address - Phone:617-863-0833
Mailing Address - Fax:800-555-2336
Practice Address - Street 1:1234 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144
Practice Address - Country:US
Practice Address - Phone:617-863-0833
Practice Address - Fax:800-555-2336
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1136621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical