MEDICARE: SARAH LYNN 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	101YP2500X	Professional Counselor	37PC00697400	NJ
2	101YP2500X	Professional Counselor	84234	TX
3	101YP2500X	Professional Counselor	PC011611	PA
4	101YM0800X	Mental Health Counselor	009570	NY

General Provider Information

NPI Number	:	1356984371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LYNN DAVIS

Provider Business Mailing Address
First Line	:	255 W 94TH ST APT 20H
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-9652
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 W 71ST ST APT 1
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-3747
Country	:	US
Telephone Number	:	212-847-0695
Fax Number	:

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

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	11/05/2020

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