Provider Demographics
NPI:1811075963
Name:DAVIS, JOYCE (LICSW)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 LAKESIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-1118
Mailing Address - Country:US
Mailing Address - Phone:978-664-8648
Mailing Address - Fax:
Practice Address - Street 1:324 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-1329
Practice Address - Country:US
Practice Address - Phone:978-664-2566
Practice Address - Fax:978-664-8023
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1019363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043114833-08OtherPACIFICARE BEHAVIORAL HEA
MD004071OtherVALUE OPTIONS
MA004071OtherVALUE OPTIONS (NY)
MA004071OtherVALUE OPTIONS/GHI
MAP06072OtherMEDEX
MAP06072OtherBCBS FEDERAL
MA730959OtherTUFTS HEALTH PLAN
MA730959OtherTUFTS BENEFIT ADMINIST
MAP06072OtherBCBS OF MA
MA2030824OtherCIGNA BEHAVIORAL HEALTH
MA730959OtherTUFTS LIBERTY
MA2030824OtherCIGNA BEHAVIORAL HEALTH