Provider Demographics
NPI:1821163791
Name:MORTENSEN, EDMOND ANDERS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDMOND
Middle Name:ANDERS
Last Name:MORTENSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SULLY CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1504
Mailing Address - Country:US
Mailing Address - Phone:661-664-0436
Mailing Address - Fax:661-832-2772
Practice Address - Street 1:5500 MING AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4689
Practice Address - Country:US
Practice Address - Phone:661-832-2700
Practice Address - Fax:661-832-2772
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS51771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical