MEDICARE: MS. MICHELLE NICOLE 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
1	1041C0700X	Clinical Social Worker	29076	CA
2	1041C0700X	Clinical Social Worker	66429	CA

General Provider Information

NPI Number	:	1689737918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE NICOLE DAVIS LCSW

Provider Business Mailing Address
First Line	:	4701 SAN LEANDRO ST
Second Line	:	#2B
City	:	OAKLAND
State	:	CA
Zip	:	94601-5100
Country	:	US
Telephone Number	:	415-517-9451
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 SAN LEANDRO ST
Second Line	:	#2B
City	:	OAKLAND
State	:	CA
Zip	:	94601-5100
Country	:	US
Telephone Number	:	415-517-9451
Fax Number	:

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	03/02/2016

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