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General NPI Number Information
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NPI Number | 1760247753
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Entity Type | Individual
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Provider Name | LILIAN DAVIS LSW
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Gender | Female
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 390 N MADISON AVE
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City | GREENWOOD
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State | IN
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Zip | 46142-2300
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Country | US
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Telephone | 812-727-4505
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 S SARE RD APT 121
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City | BLOOMINGTON
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State | IN
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Zip | 47401-8028
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Country | US
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Telephone | 765-341-6202
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 33011075A
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License Number State | IN
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