Provider Demographics
NPI:1174531073
Name:EDMUNDSON, BETTY L (MSW LISW)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:L
Last Name:EDMUNDSON
Suffix:
Gender:F
Credentials:MSW LISW
Other - Prefix:
Other - First Name:B
Other - Middle Name:L
Other - Last Name:EDMUNDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 MACKEY AVE
Mailing Address - Street 2:BELMONT PSYCHIATRIC SERVICES
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935
Mailing Address - Country:US
Mailing Address - Phone:740-635-7792
Mailing Address - Fax:740-635-7755
Practice Address - Street 1:500 MACKEY AVE
Practice Address - Street 2:BELMONT PSYCHIATRIC SERVICES
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935
Practice Address - Country:US
Practice Address - Phone:740-635-7792
Practice Address - Fax:740-635-7755
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0000165104100000X
WVDP00515956104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW01069Medicare ID - Type Unspecified
FA9278661Medicare UPIN