Provider Demographics
NPI:1639453749
Name:DAVIS, DARCI (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DARCI
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 FLINT AVENUE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-1898
Mailing Address - Country:US
Mailing Address - Phone:607-962-1514
Mailing Address - Fax:607-654-2815
Practice Address - Street 1:164 FLINT AVENUE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-1898
Practice Address - Country:US
Practice Address - Phone:607-962-1514
Practice Address - Fax:607-654-2815
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73082613104100000X
NY72-0742281041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool