Provider Demographics
NPI:1073155255
Name:DAVIS, TRUDY-ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:TRUDY-ANN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TRUDY-ANN
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:311 NORTH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2232
Mailing Address - Country:US
Mailing Address - Phone:914-269-2172
Mailing Address - Fax:914-269-2452
Practice Address - Street 1:311 NORTH ST STE 101
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2232
Practice Address - Country:US
Practice Address - Phone:914-269-2172
Practice Address - Fax:914-269-2452
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106277174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist