Provider Demographics
NPI:1831100528
Name:DAVIS, MARGOT TROTTER (LICSW)
Entity Type:Individual
Prefix:
First Name:MARGOT
Middle Name:TROTTER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 FERNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2907
Mailing Address - Country:US
Mailing Address - Phone:617-731-4899
Mailing Address - Fax:
Practice Address - Street 1:53 LANGLEY RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1913
Practice Address - Country:US
Practice Address - Phone:617-731-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10203051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO6200Medicare PIN
MAPO6200Medicare ID - Type Unspecified