Provider Demographics
NPI:1386674893
Name:DAVIS, NANCY S (LICSW BCD)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LICSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HERITAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1816
Mailing Address - Country:US
Mailing Address - Phone:603-893-8132
Mailing Address - Fax:603-893-8132
Practice Address - Street 1:30 HERITAGE HILL RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1816
Practice Address - Country:US
Practice Address - Phone:603-893-8132
Practice Address - Fax:603-893-8132
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH1107104100000X
MA101084104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30423105Medicaid
NH30423739Medicaid
NH30423105Medicaid
NH30423739Medicaid