Provider Demographics
NPI:1891091351
Name:DAVIS, PATRICIA E (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1623
Mailing Address - Country:US
Mailing Address - Phone:215-487-3000
Mailing Address - Fax:215-487-3111
Practice Address - Street 1:4100 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127-1623
Practice Address - Country:US
Practice Address - Phone:215-487-3000
Practice Address - Fax:215-487-3111
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0158361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical