Provider Demographics
NPI:1821230749
Name:DAVIS, NANCY L (BCBA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 BLANCHARD HILL RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:NY
Mailing Address - Zip Code:13684-3106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:815 BLANCHARD HILL RD
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:NY
Practice Address - Zip Code:13684-3106
Practice Address - Country:US
Practice Address - Phone:315-347-4388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-03-1261103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst