Provider Demographics
NPI:1326325713
Name:DAVIS-DOERN, MIRIAM (LCSW-R, CASAC)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:DAVIS-DOERN
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HENNING ROAD
Mailing Address - Street 2:MYERS CENTER
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866
Mailing Address - Country:US
Mailing Address - Phone:518-581-3690
Mailing Address - Fax:
Practice Address - Street 1:15 HENNING RD
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-3749
Practice Address - Country:US
Practice Address - Phone:518-581-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046854-11041C0700X
NY6322101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)