Provider Demographics
NPI:1639387830
Name:DUNHAM-DAVIS, SALLIE ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:SALLIE
Middle Name:ELIZABETH
Last Name:DUNHAM-DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2515
Mailing Address - Country:US
Mailing Address - Phone:607-433-0209
Mailing Address - Fax:607-433-0209
Practice Address - Street 1:75 MARKET ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2515
Practice Address - Country:US
Practice Address - Phone:607-433-0209
Practice Address - Fax:607-433-0209
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027926-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52585BMedicare ID - Type Unspecified