MEDICARE: TALIA DAVIDOW

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	63350	CA
2	104100000X	Social Worker	63350	CA

General Provider Information

NPI Number	:	1386003994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALIA DAVIDOW

Provider Business Mailing Address
First Line	:	2344 6TH ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2412
Country	:	US
Telephone Number	:	510-981-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3214 CALIFORNIA ST UPPR
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-2614
Country	:	US
Telephone Number	:	650-269-2285
Fax Number	:

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

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	05/05/2022

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Directions to “ TALIA DAVIDOW ” Practice Location

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