Provider Demographics
NPI:1053591750
Name:EDWARDS, LARISSA (MSW)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22198 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-6614
Mailing Address - Country:US
Mailing Address - Phone:510-881-7622
Mailing Address - Fax:510-881-5703
Practice Address - Street 1:22198 CENTER ST
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-6614
Practice Address - Country:US
Practice Address - Phone:510-881-7622
Practice Address - Fax:510-881-5703
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator