Provider Demographics
NPI:1508927476
Name:DAVILA, DAMARIS (MA)
Entity Type:Individual
Prefix:MISS
First Name:DAMARIS
Middle Name:
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:CALLE 1 A 12
Mailing Address - Street 2:URBANIZACION CONDADO MODERNO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-604-7798
Mailing Address - Fax:
Practice Address - Street 1:CONSOLIDATED MALL LOCAL B5
Practice Address - Street 2:AVE, GAUTIER BENITEZ
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:787-704-0820
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2645103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling