Active NPI
Theresa Edwards, LLMSW
- Clinical Social Worker
- Detroit, MI
National Provider Identifier
1962875260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801095333
- Practice address
- 2925 Russell St
Detroit, MI 48207-4825 - Phone
- (313) 396-5300
- NPI assigned
- Nov 9, 2015
- Sex
- Female
- 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 Social Worker | 1041C0700X | 6801095333 | MI | Primary |
Addresses
Primary practice location
2925 Russell St
Detroit, MI 48207-4825
Mailing address
30606 Sandhurst CT
Apt 207
Roseville, MI 48066-7750
Phone (313) 539-5309
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 |
|---|---|---|---|
| 6801095333 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447027200000",
"number": "1962875260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30606 SANDHURST CT",
"address_2": "APT 207",
"city": "ROSEVILLE",
"state": "MI",
"postal_code": "480667750",
"telephone_number": "313-539-5309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2925 RUSSELL ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482074825",
"telephone_number": "313-396-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "THERESA",
"credential": "LLMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-11-09",
"last_updated": "2015-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801095333",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.