Individual
EDWARD EDGAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.A.D.C.
Contact information
Practice address
525 WOLCOTT ST, WATERBURY, CT 06705-1240
(203) 596-7870
Mailing address
525 WOLCOTT ST, WATERBURY, CT 06705-1240
(203) 596-7870
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000374
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300000374CT01
ANTHEM BLUE CROSS
CT
01
—
300000374CT02
ANTHEM BLUE CROSS
CT
Enumeration date
05/17/2007
Last updated
01/27/2012
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