Deeidra S Edmunds, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

DP00945394 Issued in WV

Practice address

302 State St
Proctorville, OH 45669-5004

Phone

(740) 479-5135

NPI assigned

Jan 30, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Deeidra S Beckett Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: deeidra.gravely@marshall.cernerdirect.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667520000000",
    "number": "1073077475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 CENTER ST FRNT B",
            "city": "IRONTON",
            "state": "OH",
            "postal_code": "456381519",
            "telephone_number": "740-479-5135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 STATE ST",
            "city": "PROCTORVILLE",
            "state": "OH",
            "postal_code": "456695004",
            "telephone_number": "740-479-5135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMUNDS",
        "first_name": "DEEIDRA",
        "middle_name": "S",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-30",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WV",
            "license": "DP00945394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "deeidra.gravely@marshall.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1600 Medical Center Dr Ste 1500",
            "city": "Huntington",
            "state": "WV",
            "country_code": "US",
            "postal_code": "257013657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DEEIDRA",
            "last_name": "BECKETT",
            "middle_name": "S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James S. Darlington, D.D.S.
• Glenn Scott Davis, M.D.
• Daystar Services LLC
• Jami Nell Dean, CPHT
• Ruby Deyoung, LPN
• Teresa Gaye Edwards
• Brenda Ellis
• Fairland Local School District
• Faith Freedom Health LLC
• Laura Fields-Ernest, MA, ED S.

• Clinical Social Worker in Proctorville, OH
• Providers in Proctorville, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.