Provider Demographics
NPI:1538263124
Name:LOEBER, EDWARD (LISW-CP)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:LOEBER
Suffix:
Gender:M
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 NE 125TH ST STE 409
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5834
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:305-891-4228
Practice Address - Street 1:1483 TOBIAS GADSON BLVD STE 107
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4795
Practice Address - Country:US
Practice Address - Phone:843-745-5153
Practice Address - Fax:843-766-8606
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8666104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01011714OtherMEDICARE RAILROAD
SCSW1033Medicaid
SCSW1033Medicaid