Provider Demographics
NPI:1801865928
Name:EDWARDS, JOSEPH C (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 NORTH ROAD SE
Mailing Address - Street 2:JOSEPH C EDWARDS PHD
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484
Mailing Address - Country:US
Mailing Address - Phone:330-856-4111
Mailing Address - Fax:330-856-5839
Practice Address - Street 1:1704 NORTH ROAD SE
Practice Address - Street 2:JOSEPH C EDWARDS PHD
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484
Practice Address - Country:US
Practice Address - Phone:330-856-4111
Practice Address - Fax:330-856-5839
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH360103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0252775Medicaid
OHCP03631Medicare ID - Type Unspecified