Provider Demographics
NPI:1174018667
Name:DAVIS, JULIET (LICSW)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 COMSTOCK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9611
Mailing Address - Country:US
Mailing Address - Phone:802-223-4744
Mailing Address - Fax:802-229-0848
Practice Address - Street 1:641 COMSTOCK RD STE 1
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9611
Practice Address - Country:US
Practice Address - Phone:802-223-4744
Practice Address - Fax:802-229-0848
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01248291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical