Provider Demographics
NPI:1790001014
Name:FRANCO-DAVENPORT, ETHEL EDA (LMSW)
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:EDA
Last Name:FRANCO-DAVENPORT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 METROPOLITAN AVE APT 5B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6923
Mailing Address - Country:US
Mailing Address - Phone:718-974-4028
Mailing Address - Fax:
Practice Address - Street 1:1650 METROPOLITAN AVE APT 5B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6923
Practice Address - Country:US
Practice Address - Phone:718-974-4028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065986104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker