Provider Demographics
NPI:1942644653
Name:DAVIS, JODY
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:WEINER DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,MSW, LCSW
Mailing Address - Street 1:203 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8270
Mailing Address - Country:US
Mailing Address - Phone:732-972-0584
Mailing Address - Fax:732-972-0584
Practice Address - Street 1:203 US HIGHWAY 9
Practice Address - Street 2:SUITE 6
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8270
Practice Address - Country:US
Practice Address - Phone:732-972-0584
Practice Address - Fax:732-972-0584
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC013357001041C0700X
NJ37F100112500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist