Provider Demographics
NPI:1275798043
Name:DAVISON, JAYNE DEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:DEE
Last Name:DAVISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3534
Mailing Address - Country:US
Mailing Address - Phone:516-785-6582
Mailing Address - Fax:
Practice Address - Street 1:970 VERMONT STREET
Practice Address - Street 2:P.S. 306
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207
Practice Address - Country:US
Practice Address - Phone:718-272-6088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028042-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker