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NPI Code Detail

MEDICARE: DIANE DAVISON LCSW

MEDICARE: DIANE DAVISON 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
11041C0700XClinical Social WorkerCW013058PA

General Provider Information

NPI Number : 1295777431
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE DAVISON LCSW
Provider Business Mailing Address
First Line : 1605 N CEDAR CREST BLVD STE 411
Second Line :
City : ALLENTOWN
State : PA
Zip : 18104-2323
Country : US
Telephone Number : 610-969-1914
Fax Number : 610-969-3951
Provider Business Practice Location Address
First Line : 2710 SCHOENERSVILLE RD
Second Line :
City : BETHLEHEM
State : PA
Zip : 18017-3574
Country : US
Telephone Number : 610-297-7500
Fax Number : 610-297-7533
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 04/27/2020

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