Healthcare Provider Details

I. General information

NPI: 1962541011
Provider Name (Legal Business Name): ANDREA MONIQUE DAVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 FEDERAL CT
GALLOWAY NJ
08205-3606
US

IV. Provider business mailing address

PO BOX 195
ABSECON NJ
08201-0195
US

V. Phone/Fax

Practice location:
  • Phone: 609-415-0568
  • Fax: --
Mailing address:
  • Phone: 609-415-0568
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06006100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0011850
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: