Provider Demographics
NPI:1851661920
Name:DAVIS, MARIE B (BSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 N FEDERAL HWY
Mailing Address - Street 2:SUITE 2S
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6519
Mailing Address - Country:US
Mailing Address - Phone:888-880-9270
Mailing Address - Fax:954-342-0273
Practice Address - Street 1:914 HARRISON AVENUE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401
Practice Address - Country:US
Practice Address - Phone:850-819-9543
Practice Address - Fax:850-747-8547
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker