Provider Demographics
NPI:1902917875
Name:EDE, BRIAN J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:EDE
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 1:100 MACTANLY PL STE B
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2383
Mailing Address - Country:US
Mailing Address - Phone:540-885-3508
Mailing Address - Fax:540-885-3508
Practice Address - Street 1:100 MACTANLY PL STE B
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2383
Practice Address - Country:US
Practice Address - Phone:540-885-3508
Practice Address - Fax:540-885-3508
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500787321041C0700X
IA063201041C0700X
VA09040100991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical