Active NPI
Garry L. Edwards, ED.D.
- Clinical Psychologist
- Vero Beach, FL
National Provider Identifier
1508087933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY0003151
- Practice address
- 1627 14TH Ave
Vero Beach, FL 32960-0435 - Phone
- (772) 562-9152
- NPI assigned
- May 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY0003151 | FL | Primary |
Addresses
Primary practice location
1627 14TH Ave
Vero Beach, FL 32960-0435
Mailing address
1627 14TH Ave
Vero Beach, FL 32960-0435
Phone (772) 562-9152
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY0003151 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1508087933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1627 14TH AVE",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "329600435",
"telephone_number": "772-562-9152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1627 14TH AVE",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "329600435",
"telephone_number": "772-562-9152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "GARRY",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY0003151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vero Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.