Healthcare Provider Details

I. General information

NPI: 1104128230
Provider Name (Legal Business Name): DEBRA MICHELE DAVIS-SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY ROOM# 5A-06
BROOKLYN NY
11206-5317
US

IV. Provider business mailing address

760 BROADWAY ROOM# 5A-06
BROOKLYN NY
11206
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-5863
  • Fax:
Mailing address:
  • Phone: 718-963-5863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR034505-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: