Provider Demographics
NPI:1568527596
Name:UNTERBACH, DAVIDA B (DSW LCSW)
Entity Type:Individual
Prefix:DR
First Name:DAVIDA
Middle Name:B
Last Name:UNTERBACH
Suffix:
Gender:F
Credentials:DSW LCSW
Other - Prefix:
Other - First Name:DEE
Other - Middle Name:B
Other - Last Name:UNTERBACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:186 OLD RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897
Mailing Address - Country:US
Mailing Address - Phone:203-834-7685
Mailing Address - Fax:203-761-6633
Practice Address - Street 1:186 OLD RIDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897
Practice Address - Country:US
Practice Address - Phone:203-834-7685
Practice Address - Fax:203-761-6633
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002378104100000X
NY16019104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
11244974OtherCAQH