Provider Demographics
NPI:1477162121
Name:DAVIS, LUCIA BELLINGER (CASAC2)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:BELLINGER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CASAC2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-0211
Mailing Address - Country:US
Mailing Address - Phone:917-359-0095
Mailing Address - Fax:518-514-1417
Practice Address - Street 1:8 SCOFIELD ST
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-1710
Practice Address - Country:US
Practice Address - Phone:845-778-5628
Practice Address - Fax:845-778-5168
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24487OtherNYS OASAS