Provider Demographics
NPI:1275094211
Name:DAVIS, SHARON T (LMSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:T
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 1:1875 ATLANTIC AVE APT 6B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-5356
Mailing Address - Country:US
Mailing Address - Phone:646-523-9530
Mailing Address - Fax:
Practice Address - Street 1:1875 ATLANTIC AVE APT 6B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-5356
Practice Address - Country:US
Practice Address - Phone:646-523-9530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
105616-1104100000X
104100000X
NY105616104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker