Provider Demographics
NPI:1851046197
Name:BEDFORD, LYNDAL EDWIN (MSW)
Entity Type:Individual
Prefix:
First Name:LYNDAL
Middle Name:EDWIN
Last Name:BEDFORD
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 1:529 TIMBERLANE E APT D
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-9119
Mailing Address - Country:US
Mailing Address - Phone:404-434-3528
Mailing Address - Fax:
Practice Address - Street 1:99 6TH ST SW STE 101
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-7902
Practice Address - Country:US
Practice Address - Phone:863-662-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW159631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical