Healthcare Provider Details

I. General information

NPI: 1821907064
Provider Name (Legal Business Name): CARISSA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 SOUTH ST STE 200
PITTSFIELD MA
01201-8243
US

IV. Provider business mailing address

31 OTTOMINE WAY
JOHNSONVILLE NY
12094-3421
US

V. Phone/Fax

Practice location:
  • Phone: 413-236-5656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: