Provider Demographics
NPI:1851588537
Name:DAVIS, KATIE PATRICIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:PATRICIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:PATRICIA
Other - Last Name:LEPINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 VIVAS DR
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2593
Mailing Address - Country:US
Mailing Address - Phone:732-861-8765
Mailing Address - Fax:
Practice Address - Street 1:119 VIVAS DR
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2593
Practice Address - Country:US
Practice Address - Phone:732-861-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051880001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical