Provider Demographics
NPI:1831557487
Name:DAVIS, XIOMARA N (LCSW, QS)
Entity type:Individual
Prefix:MRS
First Name:XIOMARA
Middle Name:N
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW, QS
Other - Prefix:
Other - First Name:XIOMARA
Other - Middle Name:N
Other - Last Name:ALVAREZ-SALAMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, QS
Mailing Address - Street 1:2030 SLOANS OUTLOOK DR
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-8214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15310 AMBERLY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2199
Practice Address - Country:US
Practice Address - Phone:813-530-5257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW166421041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW16642OtherLICENSED CLINICAL SOCIAL WORK