Provider Demographics
NPI:1346282258
Name:DAVIDSON, JOHN ALLAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLAN
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1211
Mailing Address - Country:US
Mailing Address - Phone:607-245-6259
Mailing Address - Fax:607-648-8717
Practice Address - Street 1:9 KATTELVILLE RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-5859
Practice Address - Country:US
Practice Address - Phone:607-245-6259
Practice Address - Fax:607-648-8717
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070759-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02727902Medicaid
NYRA9175Medicare ID - Type Unspecified