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NPI Code Detail

MEDICARE: CLARA LATESE DAVIS LCSW

MEDICARE: CLARA LATESE DAVIS LCSW
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
11041C0700XClinical Social WorkerLCSW-17396AZ

General Provider Information

NPI Number : 1578118527
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARA LATESE DAVIS LCSW
Provider Business Mailing Address
First Line : 1525 S HIGLEY RD STE 104
Second Line :
City : GILBERT
State : AZ
Zip : 85296-5045
Country : US
Telephone Number : 928-600-4804
Fax Number :
Provider Business Practice Location Address
First Line : 1525 S HIGLEY RD STE 104
Second Line :
City : GILBERT
State : AZ
Zip : 85296-5045
Country : US
Telephone Number : 480-818-9992
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2019
Last Update Date : 08/07/2019

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