Provider Demographics
NPI:1710124839
Name:EDWARDS, BRAD DAVID (MSW)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:DAVID
Last Name:EDWARDS
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 1:3150 HOOMUA DR
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9443
Mailing Address - Country:US
Mailing Address - Phone:808-250-7929
Mailing Address - Fax:
Practice Address - Street 1:3150 HOOMUA DR
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-9443
Practice Address - Country:US
Practice Address - Phone:808-250-7929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW #17554390200000X
HI38961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program