Provider Demographics
NPI:1154532232
Name:EDWARDS, INGRID ELISE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:ELISE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 FIRETHORNE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-1617
Mailing Address - Country:US
Mailing Address - Phone:412-398-3578
Mailing Address - Fax:412-373-3276
Practice Address - Street 1:500 LAUREL DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-1136
Practice Address - Country:US
Practice Address - Phone:412-398-3578
Practice Address - Fax:412-373-3276
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0153171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101852362 0001Medicaid