Provider Demographics
NPI:1609952720
Name:DAVENPORT, DAVID ANDREW SR (EDD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANDREW
Last Name:DAVENPORT
Suffix:SR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-1225
Mailing Address - Country:US
Mailing Address - Phone:856-769-7255
Mailing Address - Fax:856-769-7281
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08098-1225
Practice Address - Country:US
Practice Address - Phone:856-769-7255
Practice Address - Fax:856-769-7281
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3763103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist