Provider Demographics
NPI:1700404621
Name:MATTHEW H DAVIS LCSW, PLLC
Entity Type:Organization
Organization Name:MATTHEW H DAVIS LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:H
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:716-202-8877
Mailing Address - Street 1:90 SYLVAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1109
Mailing Address - Country:US
Mailing Address - Phone:716-202-8877
Mailing Address - Fax:716-463-2226
Practice Address - Street 1:90 SYLVAN PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14228-1109
Practice Address - Country:US
Practice Address - Phone:716-202-8877
Practice Address - Fax:716-463-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty