John Benjamin Edwards, MSW, ACSW, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

C000554 Issued in NC

Practice address

325 N Main St
Tarboro, NC 27886-5009

Phone

(252) 823-2927

Fax

(252) 823-8792

NPI assigned

Jan 26, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Marvin D. Coulthard

  dba Tar River Psychological Associates

  • Mental Health Counselor
  • Tarboro, NC
  • NPI 1336283837

  Social Worker

  NPD (past)

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851447106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 N MAIN ST",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278865009",
            "telephone_number": "252-823-2927",
            "fax_number": "252-823-8792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N MAIN ST",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278865009",
            "telephone_number": "252-823-2927",
            "fax_number": "252-823-8792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "JOHN",
        "middle_name": "BENJAMIN",
        "name_prefix": "Mr.",
        "credential": "MSW, ACSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NC",
            "license": "C000554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "53901",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "131UR",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6002083",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edge Combe County Public Schools
• Edgecombe Chiropractic Inc (Hammer Chiropractic Tarboro)
• Edgecombe County
• Edgecombe Health Center by Harborview, LLC (Edgecombe Health Center by Harborview)
• Edgecombe Nash Mental Health
• Enriched Living, LLC
• Epic Supports and Services
• Evangelistic Deliverance Center Adult Group Home
• Joy Rogers Evans
• Everwell Health Services, LLC

• Social Worker in Tarboro, NC
• Providers in Tarboro, NC by specialty
• Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.