Provider Demographics
NPI:1225180920
Name:DAVIS, ARNOLD GARDNER JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ARNOLD
Middle Name:GARDNER
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OAK LN
Mailing Address - Street 2:
Mailing Address - City:EAST WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04030-5119
Mailing Address - Country:US
Mailing Address - Phone:207-247-4222
Mailing Address - Fax:
Practice Address - Street 1:813 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04087-3006
Practice Address - Country:US
Practice Address - Phone:207-247-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC12581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical