Healthcare Provider Details

I. General information

NPI: 1740368232
Provider Name (Legal Business Name): DAVID JAMES DAVIS L.C.S.W.-R
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CONKEY AVENUE 5TH FLOOR BOX 136
NORWICH NY
13815-2711
US

IV. Provider business mailing address

24-26 CONKEY AVENUE ROOM 308
NORWICH NY
13815-2711
US

V. Phone/Fax

Practice location:
  • Phone: 607-334-5010
  • Fax: 607-336-7326
Mailing address:
  • Phone: 607-316-5823
  • Fax: 607-336-7326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR034504-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: