Provider Demographics
NPI:1366623894
Name:MARIE SUSAN DAVILA, LCSW
Entity Type:Organization
Organization Name:MARIE SUSAN DAVILA, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-563-0013
Mailing Address - Street 1:35 COLD SPRING RD
Mailing Address - Street 2:BLDG 100 STE 124
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3160
Mailing Address - Country:US
Mailing Address - Phone:860-563-0013
Mailing Address - Fax:860-529-1973
Practice Address - Street 1:35 COLD SPRING RD
Practice Address - Street 2:BLDG 100 STE 124
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3160
Practice Address - Country:US
Practice Address - Phone:860-563-0013
Practice Address - Fax:860-529-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty