Provider Demographics
NPI:1235200163
Name:DAVIS, ANDREW STEWART (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:STEWART
Last Name:DAVIS
Suffix:
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 1:1605 KATHY DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1718
Mailing Address - Country:US
Mailing Address - Phone:609-751-4253
Mailing Address - Fax:
Practice Address - Street 1:2550 BRUNSWICK PIKE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4103
Practice Address - Country:US
Practice Address - Phone:609-396-8877
Practice Address - Fax:609-396-6024
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05406100104100000X
NJ44SC055678001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker