Provider Demographics
NPI:1689366551
Name:DAVIS, LA SHAWN ROSAMOND (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LA SHAWN
Middle Name:ROSAMOND
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1013
Mailing Address - Country:US
Mailing Address - Phone:716-308-7695
Mailing Address - Fax:
Practice Address - Street 1:279 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1013
Practice Address - Country:US
Practice Address - Phone:716-495-3695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0577760104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker