Provider Demographics
NPI:1275101438
Name:DAVIS, ELISABETH
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SPRUCE ST # A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3546
Mailing Address - Country:US
Mailing Address - Phone:857-991-8171
Mailing Address - Fax:
Practice Address - Street 1:155 MAIN ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-0310
Practice Address - Country:US
Practice Address - Phone:857-991-8171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician