Provider Demographics
NPI:1699198887
Name:DAVIS, SHARON (LSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 CAMPBELL MILL RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-7123
Mailing Address - Country:US
Mailing Address - Phone:570-850-3682
Mailing Address - Fax:570-523-3032
Practice Address - Street 1:72 CAMPBELL MILL RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-7123
Practice Address - Country:US
Practice Address - Phone:570-850-3682
Practice Address - Fax:570-523-3032
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129889104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker