Provider Demographics
NPI:1649318817
Name:EDWARDS, JANETTE E (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JANETTE
Middle Name:E
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 1:5991 CHESTER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2265
Mailing Address - Country:US
Mailing Address - Phone:904-448-1992
Mailing Address - Fax:904-448-8866
Practice Address - Street 1:5991 CHESTER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2269
Practice Address - Country:US
Practice Address - Phone:904-448-1992
Practice Address - Fax:904-448-8866
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSOW0021851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2966Medicare ID - Type UnspecifiedPROVIDER NUMBER