Active NPI
Vincent John Edwards, LCSW
- Clinical Social Worker
- Putnam, CT
National Provider Identifier
1992807457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 005418
- Practice address
- 36 Church St
Putnam, CT 06260-1866 - Phone
- (860) 792-6099
- Fax
- (860) 792-6099
- NPI assigned
- Sep 3, 2006
- 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 Social Worker | 1041C0700X | 005418 | CT | Primary |
Addresses
Primary practice location
36 Church St
Putnam, CT 06260-1866
Mailing address
549 Taft Pond Rd
Pomfret Center, CT 06259-1315
Phone (860) 933-8597
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005418 | CT | MD | Clinical Social Worker |
Interoperability endpoints
- vince.edwards.1@29658.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514332800000",
"number": "1992807457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "549 TAFT POND RD",
"city": "POMFRET CENTER",
"state": "CT",
"postal_code": "062591315",
"telephone_number": "860-933-8597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 CHURCH ST",
"city": "PUTNAM",
"state": "CT",
"postal_code": "062601866",
"telephone_number": "860-792-6099",
"fax_number": "860-792-6099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "VINCENT",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-03",
"last_updated": "2017-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "005418",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Putnam, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.