MEDICARE: ROBIN G. DAVENPORT LPC

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	101Y00000X	Counselor	37PC00038700	NJ

General Provider Information

NPI Number	:	1891034286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN G. DAVENPORT LPC

Provider Business Mailing Address
First Line	:	1 CROWELL PL
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-1315
Country	:	US
Telephone Number	:	973-763-9165
Fax Number	:

Provider Business Practice Location Address
First Line	:	697 VALLEY ST
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2641
Country	:	US
Telephone Number	:	973-763-9165
Fax Number	:

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

Provider Enumeration Date	:	02/05/2013
Last Update Date	:	02/05/2013

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