Provider Demographics
NPI:1023481934
Name:EDWARDS, GARY JOSEPH (LMHC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:JOSEPH
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6956 STATE HIGHWAY 56
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3628
Mailing Address - Country:US
Mailing Address - Phone:315-268-0264
Mailing Address - Fax:315-268-0200
Practice Address - Street 1:6956 STATE HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3628
Practice Address - Country:US
Practice Address - Phone:315-268-0264
Practice Address - Fax:315-268-0200
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health