Healthcare Provider Details

I. General information

NPI: 1275540965
Provider Name (Legal Business Name): PATRICIA SACCA DAVIES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. PATRICIA SACCA DOMBROWSKI

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 SUFFIELD ST SUITE 4
AGAWAN MA
01001-1753
US

IV. Provider business mailing address

46 SUFFIELD ST SUITE 4
AGAWAN MA
01001-1753
US

V. Phone/Fax

Practice location:
  • Phone: 413-786-3701
  • Fax: 413-786-3758
Mailing address:
  • Phone: 413-786-3701
  • Fax: 413-786-3758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2246
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: