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Individual

JENNIFER L EDGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LICSW

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW02865
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
146467
ANTHEM BCBS
VA
Enumeration date
11/09/2006
Last updated
12/31/2020
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