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General NPI Number Information
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NPI Number | 1619366895
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Entity Type | Individual
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Provider Name | ROBERT DAVIS
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Gender | Male
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 35 CONGRESS ST STE 214
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City | SALEM
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State | MA
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Zip | 01970-7312
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Country | US
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Telephone | 78-542-1951
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Fax |
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Provider Business Mailing Address
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Address Line | 81 STARK ST APT 5
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City | MANCHESTER
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State | NH
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Zip | 03101-1930
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Country | US
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Telephone | 401-536-4689
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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