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NPI Code Detail

MEDICARE: ROBYN S DAVIS LCSW

MEDICARE: ROBYN S 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
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1336356245
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBYN S DAVIS LCSW
Provider Business Mailing Address
First Line : 1800 CROWN RD
Second Line :
City : HERRIN
State : IL
Zip : 62948-6524
Country : US
Telephone Number : 618-988-8349
Fax Number :
Provider Business Practice Location Address
First Line : 109 LOU ANN DR
Second Line :
City : HERRIN
State : IL
Zip : 62948-3733
Country : US
Telephone Number : 618-988-1330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2007
Last Update Date : 07/08/2007

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