Provider Demographics
NPI:1235393265
Name:DAVIS, LAURA ELLEN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ELLEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BRYANT TRL
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-5731
Mailing Address - Country:US
Mailing Address - Phone:845-553-5865
Mailing Address - Fax:914-925-5174
Practice Address - Street 1:275 NORTH ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1524
Practice Address - Country:US
Practice Address - Phone:914-925-5449
Practice Address - Fax:914-925-5174
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0750351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical