MEDICARE: GWENDOLYN YVETTE DAVIS LCSW, PHD

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	CW018437	PA

General Provider Information

NPI Number	:	1225989189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN YVETTE DAVIS LCSW, PHD

Provider Business Mailing Address
First Line	:	2405 N 53RD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2421
Country	:	US
Telephone Number	:	215-868-3729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 W LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-2760
Country	:	US
Telephone Number	:	215-226-8800
Fax Number	:

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

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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