Provider Demographics
NPI:1235125691
Name:DAVIS, ROBERT WARREN (MSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WARREN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FRANKLIN SQ
Mailing Address - Street 2:SUITE D
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2141
Mailing Address - Country:US
Mailing Address - Phone:518-587-8402
Mailing Address - Fax:518-587-8402
Practice Address - Street 1:4 FRANKLIN SQ
Practice Address - Street 2:SUITE D
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2141
Practice Address - Country:US
Practice Address - Phone:518-587-8402
Practice Address - Fax:518-587-8402
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0413061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02213156Medicaid
NYCC9026Medicare ID - Type UnspecifiedMEDICARE