Provider Demographics
NPI:1780457309
Name:DAVIS, GILBERT
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:N PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07063-1610
Mailing Address - Country:US
Mailing Address - Phone:732-822-9190
Mailing Address - Fax:
Practice Address - Street 1:706 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:N PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07063-1610
Practice Address - Country:US
Practice Address - Phone:732-822-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty