Provider Demographics
NPI:1336257898
Name:DAVIS, ROBERT WARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WARD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2414
Mailing Address - Country:US
Mailing Address - Phone:415-355-3570
Mailing Address - Fax:415-350-6750
Practice Address - Street 1:1650 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2414
Practice Address - Country:US
Practice Address - Phone:415-355-3570
Practice Address - Fax:415-355-6750
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS126181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31479ZMedicare ID - Type Unspecified