Provider Demographics
NPI:1710909114
Name:WOODWARDS-DAVILA, DORIS J (LISW-S)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:J
Last Name:WOODWARDS-DAVILA
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 MIDWAY BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-9006
Mailing Address - Country:US
Mailing Address - Phone:440-324-1300
Mailing Address - Fax:440-324-0070
Practice Address - Street 1:347 MIDWAY BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-9006
Practice Address - Country:US
Practice Address - Phone:440-324-1300
Practice Address - Fax:440-324-0070
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0005447-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000124727OtherANTHEM BLUE CROSS PIN