Provider Demographics
NPI:1710762661
Name:DAVIS, TAYLOR CHRISTINA (LMSW-LP)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:CHRISTINA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1381
Mailing Address - Country:US
Mailing Address - Phone:315-788-1530
Mailing Address - Fax:
Practice Address - Street 1:595 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1381
Practice Address - Country:US
Practice Address - Phone:315-788-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72-P123969-01101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor