Provider Demographics
NPI:1811903941
Name:EDWARDS, JAMES STEPHEN (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:STEPHEN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:MR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:11708 CRESTVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-9700
Mailing Address - Country:US
Mailing Address - Phone:765-434-6602
Mailing Address - Fax:
Practice Address - Street 1:1907 W. SYCAMORE STREET
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46904-9010
Practice Address - Country:US
Practice Address - Phone:765-456-5900
Practice Address - Fax:765-456-5387
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002244A1041C0700X
IN80000015A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000343457OtherANTHEM BX/BS ID NUMBER
IN11347475OtherCAQH ID NUMBER
IN2069517OtherCIGNA ID NUMBER
INEDWAR-0013OtherCOMPCARE ID NUMBER