MEDICARE: LARNETTE DAVIS(JONES) LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker		PA

General Provider Information

NPI Number	:	1124646179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARNETTE DAVIS(JONES) LSW

Provider Business Mailing Address
First Line	:	16 W MOWRY ST
Second Line	:
City	:	CHESTER
State	:	PA
Zip	:	19013-5022
Country	:	US
Telephone Number	:	610-306-8137
Fax Number	:

Provider Business Practice Location Address
First Line	:	4224 N FRONT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2714
Country	:	US
Telephone Number	:	215-845-2670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	07/07/2020

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