Provider Demographics
NPI:1740368232
Name:DAVIS, DAVID JAMES (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAMES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24-26 CONKEY AVENUE
Mailing Address - Street 2:ROOM 308
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-2711
Mailing Address - Country:US
Mailing Address - Phone:607-316-5823
Mailing Address - Fax:607-336-7326
Practice Address - Street 1:26 CONKEY AVENUE 5TH FLOOR
Practice Address - Street 2:BOX 136
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-2711
Practice Address - Country:US
Practice Address - Phone:607-334-5010
Practice Address - Fax:607-336-7326
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR034504-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
J300046370Medicare PIN