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General NPI Number Information
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NPI Number | 1366190829
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Entity Type | Individual
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Provider Name | JACLYN MARIE DAVIS MA/CAS
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Gender | Female
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 9 CENTRAL PARK PLACE
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City | HOMER
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State | NY
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Zip | 13077
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Country | US
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Telephone | 607-749-1250
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Fax |
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Provider Business Mailing Address
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Address Line | 453 SURREY DR
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City | CORTLAND
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State | NY
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Zip | 13045-9378
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Country | US
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Telephone | 607-342-4378
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Fax |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 965888151
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License Number State | NY
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