Provider Demographics
NPI:1053176404
Name:EDMUNDS, ROBERT JUSTIN (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JUSTIN
Last Name:EDMUNDS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4034 CHARWOOD CIR APT 9
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-2937
Mailing Address - Country:US
Mailing Address - Phone:859-468-6371
Mailing Address - Fax:
Practice Address - Street 1:600 US 31W BYP
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4906
Practice Address - Country:US
Practice Address - Phone:270-782-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2572841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical