Provider Demographics
NPI:1730677691
Name:DAVIS, SAVANNAH (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 OCEAN ST STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2828
Mailing Address - Country:US
Mailing Address - Phone:207-631-0920
Mailing Address - Fax:
Practice Address - Street 1:63 OCEAN ST STE B
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2828
Practice Address - Country:US
Practice Address - Phone:207-631-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC185391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical