Provider Demographics
NPI:1588737696
Name:EDGAR, JANE H (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:H
Last Name:EDGAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 JONESTOWN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-4021
Mailing Address - Country:US
Mailing Address - Phone:717-671-9520
Mailing Address - Fax:717-671-9524
Practice Address - Street 1:5405 JONESTOWN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-4021
Practice Address - Country:US
Practice Address - Phone:717-671-9520
Practice Address - Fax:717-671-9524
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0128281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAED616818Medicare ID - Type Unspecified