MEDICARE: MICHELLE L 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	SW17064	FL

General Provider Information

NPI Number	:	1215560354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE L DAVIS LCSW

Provider Business Mailing Address
First Line	:	502 RICH DR
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-6554
Country	:	US
Telephone Number	:	561-312-5846
Fax Number	:

Provider Business Practice Location Address
First Line	:	1480 ROYAL PALM BEACH BLVD STE C
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1608
Country	:	US
Telephone Number	:	561-312-5846
Fax Number	:

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

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	07/27/2020

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