Provider Demographics
NPI:1780200949
Name:DAVIS, LOUIS RICHARD (LMSW)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:RICHARD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 MAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-5512
Mailing Address - Country:US
Mailing Address - Phone:315-335-2328
Mailing Address - Fax:315-339-1912
Practice Address - Street 1:417 E GERMAN ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1028
Practice Address - Country:US
Practice Address - Phone:315-868-1000
Practice Address - Fax:315-866-3174
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052857101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health