Provider Demographics
NPI:1902388556
Name:DAVIN, PAUL VINCENT (LICSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:VINCENT
Last Name:DAVIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:V
Other - Last Name:DAVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:10 PARSONS WALK
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2830
Mailing Address - Country:US
Mailing Address - Phone:339-933-1519
Mailing Address - Fax:
Practice Address - Street 1:90 WARREN AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-6105
Practice Address - Country:US
Practice Address - Phone:339-933-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10202021041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool