Provider Demographics
NPI:1750850897
Name:EDWARDS, ARLENE L (MA, LPC, ICAADC)
Entity Type:Individual
Prefix:MS
First Name:ARLENE
Middle Name:L
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA, LPC, ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S COURTLAND ST UNIT 1283
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-5049
Mailing Address - Country:US
Mailing Address - Phone:570-801-8580
Mailing Address - Fax:
Practice Address - Street 1:200 S COURTLAND ST UNIT 1283
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-5049
Practice Address - Country:US
Practice Address - Phone:570-801-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NJ37PC00847000101YP2500X
PAPC012163101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037927310001Medicaid