Provider Demographics
NPI:1457688657
Name:DAVIS, CAROLYN (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
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 1:4 SUMMIT RD
Mailing Address - Street 2:C
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1485
Mailing Address - Country:US
Mailing Address - Phone:203-758-0755
Mailing Address - Fax:203-758-0754
Practice Address - Street 1:4 SUMMIT RD
Practice Address - Street 2:C
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1485
Practice Address - Country:US
Practice Address - Phone:203-758-0755
Practice Address - Fax:203-758-0754
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0039751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical