Provider Demographics
NPI:1336299486
Name:DAVIS, ALPHONSE L (MASTER OF SW)
Entity Type:Individual
Prefix:
First Name:ALPHONSE
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MASTER OF SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 MEMORIAL DR
Mailing Address - Street 2:#203
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-5052
Mailing Address - Country:US
Mailing Address - Phone:413-221-7425
Mailing Address - Fax:
Practice Address - Street 1:110 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1864
Practice Address - Country:US
Practice Address - Phone:413-732-7419
Practice Address - Fax:413-781-1059
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical