Provider Demographics
NPI:1942265012
Name:LINDBERG, EDWIN H (LMSW, LMFT, BCD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:H
Last Name:LINDBERG
Suffix:
Gender:M
Credentials:LMSW, LMFT, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1558
Mailing Address - Country:US
Mailing Address - Phone:269-352-7216
Mailing Address - Fax:269-388-2346
Practice Address - Street 1:5100 LOVERS LN
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49002-1558
Practice Address - Country:US
Practice Address - Phone:269-352-7216
Practice Address - Fax:269-388-2346
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010192221041C0700X
MI4101005537106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3402136Medicaid
MI3402136Medicaid