Provider Information for 1356912083
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JACQUELINE MARJORIE EDWARDS LPC
Sex: Female
NPI: 1356912083
Last Updated: 2021-07-04
Certification Date: 2021-07-04
Certification Date: 2021-07-04
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1356912083 | ||||||||||||||
| Enumeration Date | 2021-07-04 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 53 COLEBROOK ST HARTFORD, CT 06112-1522 United States Phone: 860-709-7894 | Fax: | ||||||||||||||
| Primary Practice Address | 53 COLEBROOK ST HARTFORD, CT 06112-1522 United States Phone: 860-709-7894 | Fax: | ||||||||||||||
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