Provider Demographics
NPI:1619219888
Name:EDWARDS, BETTYE RUTH (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:BETTYE
Middle Name:RUTH
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23721 KELLY RD APT 7
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3435
Mailing Address - Country:US
Mailing Address - Phone:586-778-3562
Mailing Address - Fax:
Practice Address - Street 1:23721 KELLY # 7
Practice Address - Street 2:
Practice Address - City:EAS POINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:586-778-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802086991104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker