Provider Demographics
NPI:1992853998
Name:DAVEY, DONNA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:DAVEY
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 1:38 PURITAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539
Mailing Address - Country:US
Mailing Address - Phone:508-693-5523
Mailing Address - Fax:508-693-8619
Practice Address - Street 1:15 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568
Practice Address - Country:US
Practice Address - Phone:508-693-5523
Practice Address - Fax:508-693-8619
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1121511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA773990000OtherMAGELLAN
MAP08420OtherBLUE CROSS BLUE SHIELD
MAP08420OtherBLUE CROSS BLUE SHIELD