Provider Demographics
NPI:1942379763
Name:REDMOND, EDWARD P JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:P
Last Name:REDMOND
Suffix:JR
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 1:303 TIMBER POINT RD
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-3320
Mailing Address - Country:US
Mailing Address - Phone:631-581-0267
Mailing Address - Fax:631-581-0267
Practice Address - Street 1:303 TIMBER POINT RD
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-3320
Practice Address - Country:US
Practice Address - Phone:631-581-0267
Practice Address - Fax:631-581-0267
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR01848411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7401620OtherVALUE OPTIONS
7401620OtherGHI
067005OtherVALUE OPTIONS
7401620OtherGHI