Provider Demographics
NPI:1417730961
Name:DAVIS, SAMANTHA (LMSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2806
Mailing Address - Country:US
Mailing Address - Phone:917-340-1284
Mailing Address - Fax:
Practice Address - Street 1:56 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2806
Practice Address - Country:US
Practice Address - Phone:917-340-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113948101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional