Provider Demographics
NPI:1891759775
Name:DAVIS, LORI KAY (LICSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KAY
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 1:183 TALCOTT RD STE 206
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-2075
Mailing Address - Country:US
Mailing Address - Phone:802-876-1100
Mailing Address - Fax:802-876-1101
Practice Address - Street 1:183 TALCOTT RD STE 206
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-2075
Practice Address - Country:US
Practice Address - Phone:802-876-1100
Practice Address - Fax:802-876-1101
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00003961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT18984OtherBLUE CROSS BLUE SHIELD
VT03-0179601OtherCBA INSURANCE
VT383032OtherMVP HEALTH CARE
VT1007616Medicaid