Healthcare Provider Details

I. General information

NPI: 1457414831
Provider Name (Legal Business Name): STEPHEN H DAVIE LCSW-R
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BOULEVARD ST
HUDSON FALLS NY
12839-1001
US

IV. Provider business mailing address

15 BOULEVARD ST
HUDSON FALLS NY
12839-1001
US

V. Phone/Fax

Practice location:
  • Phone: 518-747-2994
  • Fax: 518-747-2996
Mailing address:
  • Phone: 518-747-2994
  • Fax: 518-747-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR012566-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierTRI-CARE
Identifier TypeOTHER
Identifier StateNY
Identifier Issuer12034176
# 2
IdentifierMVP
Identifier TypeOTHER
Identifier StateNY
Identifier Issuer377615
# 3
IdentifierVALUE OPTIONS
Identifier TypeOTHER
Identifier StateNY
Identifier Issuer476662
# 4
IdentifierVALUE OPTIONS
Identifier TypeOTHER
Identifier StateNY
Identifier Issuer7340690002
# 5
IdentifierBCBS OF NE NY
Identifier TypeOTHER
Identifier StateNY
Identifier Issuer000403428001
# 6
IdentifierFIDELIS
Identifier TypeOTHER
Identifier StateNY
Identifier Issuer050721000016

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: