Healthcare Provider Details

I. General information

NPI: 1104886084
Provider Name (Legal Business Name): STEVEN T DAVIES L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 HAYNES ST
MANCHESTER CT
06040-4131
US

IV. Provider business mailing address

66 BRANDY ST
BOLTON CT
06043-7602
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-1222
  • Fax: 860-533-3452
Mailing address:
  • Phone: 860-643-5699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000623
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: