Healthcare Provider Details

I. General information

NPI: 1942481528
Provider Name (Legal Business Name): EILEEN DAVEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2007
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVENUE
JBER AK
99506
US

IV. Provider business mailing address

5955 ZEAMER AVENUE
JBER AK
99506
US

V. Phone/Fax

Practice location:
  • Phone: 907-201-5376
  • Fax:
Mailing address:
  • Phone: 907-201-5376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number798
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMH3715
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: