MEDICARE: DEBRA V DAVIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW22221	FL

General Provider Information

NPI Number	:	1013787704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA V DAVIS

Provider Business Mailing Address
First Line	:	508 FLOTILLA RD
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-4827
Country	:	US
Telephone Number	:	561-596-4455
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 FLOTILLA RD
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-4827
Country	:	US
Telephone Number	:	561-596-4455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	01/31/2024

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