Provider Demographics
NPI:1639269905
Name:HIDA, EDWARD T (MSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:T
Last Name:HIDA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 N 73RD ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1812
Mailing Address - Country:US
Mailing Address - Phone:414-453-1224
Mailing Address - Fax:414-454-0425
Practice Address - Street 1:2109 N 73RD ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1812
Practice Address - Country:US
Practice Address - Phone:414-453-1224
Practice Address - Fax:414-454-0425
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI512-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical