Provider Demographics
NPI:1376671354
Name:DAVIS, FERN SPELLMAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:FERN
Middle Name:SPELLMAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:FERN
Other - Middle Name:ALEXIS
Other - Last Name:SPELLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:438 HAYSTACK DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-8316
Mailing Address - Country:US
Mailing Address - Phone:302-369-1155
Mailing Address - Fax:
Practice Address - Street 1:260 CHAPMAN RD
Practice Address - Street 2:SUITE 203 A
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5490
Practice Address - Country:US
Practice Address - Phone:302-981-2809
Practice Address - Fax:302-369-1155
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0000152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE11403150OtherCAQH