Provider Demographics
NPI:1841402070
Name:EDWARDS, LISA J (LSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6313 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3067
Mailing Address - Country:US
Mailing Address - Phone:937-270-8937
Mailing Address - Fax:
Practice Address - Street 1:1170 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-1825
Practice Address - Country:US
Practice Address - Phone:937-865-9061
Practice Address - Fax:937-865-9069
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker