Provider Demographics
NPI:1831316918
Name:DAVILA, MARK (MSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:DAVILA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 MASSACHUSETTS AVE STE 802
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3363
Mailing Address - Country:US
Mailing Address - Phone:617-771-0810
Mailing Address - Fax:
Practice Address - Street 1:678 MASSACHUSETTS AVE STE 802
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3363
Practice Address - Country:US
Practice Address - Phone:617-771-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2139811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical