Doctor Name: | GARY JOSEPH EDWARDS |
NPI Number: | 1023481934 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMHC |
License Number: | |
Business Practice Address: | 6956 State Highway 56 Potsdam, NY - 136763628 |
Business Phone Number: | 3152680264 |
Business Fax Number: | 3152680200 |
Mailing Address: | 6956 State Highway 56, POTSDAM |
State: | NY |
Postal Code: | 136763628 |
Phone Number: | 3152680264 |
Fax Number: | 3152680200 |
NPI Enumeration Date: | 11/02/2015 |
NPI Last Update Date: | 11/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |