Provider Demographics
NPI:1588030233
Name:DAVIS-MILLIS, SIMON
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:DAVIS-MILLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 HYDE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2648
Mailing Address - Country:US
Mailing Address - Phone:617-357-0900
Mailing Address - Fax:
Practice Address - Street 1:1415 HYDE PARK AVE
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2648
Practice Address - Country:US
Practice Address - Phone:617-357-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker