Provider Demographics
NPI:1205928215
Name:DAVIS, PATRICIA GORDON (ISW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:GORDON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W FLAGLER ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1806
Mailing Address - Country:US
Mailing Address - Phone:305-349-1337
Mailing Address - Fax:
Practice Address - Street 1:28 W FLAGLER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1806
Practice Address - Country:US
Practice Address - Phone:305-349-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLISW61141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4660OtherFLORIDA CERTIFICATION BOARD
FLISW6114OtherFLORIDA DOH