MEDICARE: RACHEL DAVIS LCSW-C

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	21218	MD

General Provider Information

NPI Number	:	1417409715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL DAVIS LCSW-C

Provider Business Mailing Address
First Line	:	23413 NICHOLSON ST
Second Line	:
City	:	HOLLYWOOD
State	:	MD
Zip	:	20636-3289
Country	:	US
Telephone Number	:	443-975-9172
Fax Number	:

Provider Business Practice Location Address
First Line	:	8780 PASEO DE VALENCIA ST
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-9657
Country	:	US
Telephone Number	:	443-975-9172
Fax Number	:

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

Provider Enumeration Date	:	11/03/2016
Last Update Date	:	12/21/2022

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