Provider Demographics
NPI:1740372853
Name:EDWARDS, JOANNA TYLER
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:TYLER
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2706 CORTLAND PLACE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008
Mailing Address - Country:US
Mailing Address - Phone:301-896-6200
Mailing Address - Fax:202-667-9766
Practice Address - Street 1:4405 EAST WEST HIGHWAY
Practice Address - Street 2:SUITE 312
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-596-6200
Practice Address - Fax:202-667-9766
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
491635Medicare ID - Type Unspecified