Provider Demographics
NPI:1184189243
Name:DAVIS, WENDY J (LSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:C
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:6 MICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4930
Mailing Address - Country:US
Mailing Address - Phone:215-740-9800
Mailing Address - Fax:
Practice Address - Street 1:6 MICHAEL RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4930
Practice Address - Country:US
Practice Address - Phone:215-740-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW012409L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker