Provider Demographics
NPI:1679985451
Name:DAVIS, MARIE KATHRYN
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:KATHRYN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3016
Mailing Address - Country:US
Mailing Address - Phone:508-498-2567
Mailing Address - Fax:
Practice Address - Street 1:319 WILDER ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1731
Practice Address - Country:US
Practice Address - Phone:978-452-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program