=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376415810
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE C DAVIS MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2025
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1107 QUINTILIO DR
-----------------------------------------------------
City | BEAR
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-276-9590
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 AUCKLAND DR
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19702-4257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-905-1510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | Q1-0001588
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------