Provider Demographics
NPI:1770211021
Name:DAVIS-DAY, TALYA
Entity type:Individual
Prefix:
First Name:TALYA
Middle Name:
Last Name:DAVIS-DAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30C BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3502
Mailing Address - Country:US
Mailing Address - Phone:207-730-8932
Mailing Address - Fax:
Practice Address - Street 1:86 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2644
Practice Address - Country:US
Practice Address - Phone:203-245-0412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6526104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6526OtherLMSW LICENSE 2022