Provider Demographics
NPI:1023478609
Name:EDWARDS-ROBERTS, MORRONDO (LISW-S, LICDC-CS)
Entity type:Individual
Prefix:
First Name:MORRONDO
Middle Name:
Last Name:EDWARDS-ROBERTS
Suffix:
Gender:M
Credentials:LISW-S, LICDC-CS
Other - Prefix:
Other - First Name:MORRONDO
Other - Middle Name:
Other - Last Name:EDWARDS-ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:323-467-7119
Practice Address - Street 1:735 PIEDMONT AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1416
Practice Address - Country:US
Practice Address - Phone:404-588-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.13024191041C0700X
GACSW0069601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0160966Medicaid