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General NPI Number Information
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NPI Number | 1235393265
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Entity Type | Individual
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Provider Name | LAURA ELLEN DAVIS LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 275 NORTH ST
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City | HARRISON
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State | NY
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Zip | 10528-1524
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Country | US
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Telephone | 914-925-5449
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Fax | 914-925-5174
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Provider Business Mailing Address
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Address Line | 76 BRYANT TRL
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City | CARMEL
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State | NY
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Zip | 10512-5731
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Country | US
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Telephone | 845-553-5865
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Fax | 914-925-5174
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 075035
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License Number State | NY
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