Healthcare Provider Details

I. General information

NPI: 1700716750
Provider Name (Legal Business Name): AMY LYNN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 HIGHLAND AVE
SOMERVILLE MA
02144-2521
US

IV. Provider business mailing address

356 HIGHLAND AVE
SOMERVILLE MA
02144-2521
US

V. Phone/Fax

Practice location:
  • Phone: 617-680-3624
  • Fax:
Mailing address:
  • Phone: 617-680-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000009734
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: