Provider Demographics
NPI:1356650352
Name:DAVIS, AZIZI JOHARI DAEMA (LMSW,MSED)
Entity Type:Individual
Prefix:MS
First Name:AZIZI
Middle Name:JOHARI DAEMA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW,MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 EDGEWORTH ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3236
Mailing Address - Country:US
Mailing Address - Phone:516-872-1831
Mailing Address - Fax:
Practice Address - Street 1:96 EDGEWORTH ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3236
Practice Address - Country:US
Practice Address - Phone:516-872-1831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-25
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080988-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical