Provider Demographics
NPI:1366504516
Name:DAVIS, PATRICIA K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:K
Last Name:DAVIS
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 1:37 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-1914
Mailing Address - Country:US
Mailing Address - Phone:207-729-4004
Mailing Address - Fax:207-406-7601
Practice Address - Street 1:1 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1768
Practice Address - Country:US
Practice Address - Phone:207-406-7600
Practice Address - Fax:207-406-7601
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC58451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11540376OtherCAQH
MEE400198585Medicare PIN