Provider Demographics
NPI:1477626075
Name:DAVILA, WANDA I (MA)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:I
Last Name:DAVILA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 MEMORIAL DR APT 249
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-5040
Mailing Address - Country:US
Mailing Address - Phone:413-592-0835
Mailing Address - Fax:
Practice Address - Street 1:235 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5123
Practice Address - Country:US
Practice Address - Phone:413-532-0389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health