MEDICARE: LAURA DAVIS LCSW

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	1041C0700X	Clinical Social Worker	CW021205	PA
2	1041C0700X	Clinical Social Worker	44SC05791500	NJ

General Provider Information

NPI Number	:	1174261267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA DAVIS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 226
Second Line	:
City	:	BEACHWOOD
State	:	NJ
Zip	:	08722-0226
Country	:	US
Telephone Number	:	732-691-1539
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 BEAVER DAM RD STE 201
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-5171
Country	:	US
Telephone Number	:	732-503-8627
Fax Number	:

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

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	04/10/2024

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