Healthcare Provider Details

I. General information

NPI: 1851514178
Provider Name (Legal Business Name): DAVIS AND NEZELEK CLINICAL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 MAIN ST SUITE B
SIDNEY NY
13838-1112
US

IV. Provider business mailing address

76 MAIN ST SUITE B
SIDNEY NY
13838-1112
US

V. Phone/Fax

Practice location:
  • Phone: 607-563-4080
  • Fax:
Mailing address:
  • Phone: 607-563-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. MARGARET ANNE NEZELEK
Title or Position: L.C.S.W.
Credential: M.S.W.
Phone: 607-563-4080