Provider Demographics
NPI:1033362769
Name:DAVIS, ERAINA RICKS (SPECIAL EDUCATOR)
Entity Type:Individual
Prefix:
First Name:ERAINA
Middle Name:RICKS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SPECIAL EDUCATOR
Other - Prefix:
Other - First Name:ERAIN
Other - Middle Name:SERVICES
Other - Last Name:INC.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3557 FROST RD
Mailing Address - Street 2:
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-1801
Mailing Address - Country:US
Mailing Address - Phone:914-299-9845
Mailing Address - Fax:914-962-2645
Practice Address - Street 1:3 THE BLVD
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4209
Practice Address - Country:US
Practice Address - Phone:914-632-9109
Practice Address - Fax:914-632-9171
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-26
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12640-174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist