Provider Demographics
NPI:1750410031
Name:DAVIS, CLAUDIUS A (PHD, LCSWR, CASAC)
Entity type:Individual
Prefix:DR
First Name:CLAUDIUS
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHD, LCSWR, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-0951
Mailing Address - Country:US
Mailing Address - Phone:631-722-5657
Mailing Address - Fax:
Practice Address - Street 1:300 CENTER DR
Practice Address - Street 2:RIVERHEAD MENTAL HEALTH CLINIC-2ND FLOOR
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3393
Practice Address - Country:US
Practice Address - Phone:631-852-1440
Practice Address - Fax:631-852-1448
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9598101YA0400X
NYR047170-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7C871Medicare ID - Type Unspecified