Provider Demographics
NPI:1932478948
Name:DAVIS, RANDI (LMSW)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 GETZ AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2000
Mailing Address - Country:US
Mailing Address - Phone:917-862-3144
Mailing Address - Fax:
Practice Address - Street 1:174 TALLMAN STREET
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2000
Practice Address - Country:US
Practice Address - Phone:917-862-3144
Practice Address - Fax:718-442-2790
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0851791104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker