Provider Demographics
NPI:1659925089
Name:EDWARDS, REBECCA CARLSEN (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CARLSEN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 WEYBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1068
Mailing Address - Country:US
Mailing Address - Phone:941-773-4846
Mailing Address - Fax:
Practice Address - Street 1:516 WEYBRIDGE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1068
Practice Address - Country:US
Practice Address - Phone:941-773-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-120511041C0700X
NCC0140731041C0700X
PACW0218241041C0700X
VT089.01355841041C0700X
AZ198061041C0700X
AK1747871041C0700X
IN34009514A1041C0700X
TN76951041C0700X
MSC10661041C0700X
AL4692C1041C0700X
AR11391-C1041C0700X
FLSW165271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMC-12051OtherSTATE LICENSE
AL4692COtherSTATE LICENSE
TN7695OtherSTATE LICENSE
VT089.0135584OtherSTATE LICENSE
NCC014073OtherSTATE LICENSE
FLSW16527OtherSTATE LICENSE
AZ19806OtherSTATE LICENSE
MSC1066OtherSTATE LICENSE
PACW021824OtherSTATE LICENSE
IN34009514AOtherSTATE LICENSE
AR11391-COtherSTATE LICENSE
AK174787OtherSTATE LICENSE