Individual
JOHN EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
189 S 2ND ST, BROOKLYN, NY 11211-4305
(718) 384-6400
Mailing address
189 S 2ND ST, BROOKLYN, NY 11211-4305
(718) 384-6400
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20643
NY
Other
Enumeration date
11/14/2014
Last updated
11/14/2014
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