Provider Demographics
NPI:1760535025
Name:DAVIS, DENISE AMIES (LCSW)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:AMIES
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:DENISE
Other - Middle Name:ELAINE
Other - Last Name:AMIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:390 WHIG LANE ROAD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08343
Mailing Address - Country:US
Mailing Address - Phone:856-983-6400
Mailing Address - Fax:856-863-6617
Practice Address - Street 1:19 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-983-6400
Practice Address - Fax:856-863-6617
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC457921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ908519Medicare ID - Type Unspecified
S39132Medicare UPIN