MEDICARE: MS. SUSAN DAVIS LMHC

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	101Y00000X	Counselor	1509	MA
2	101YM0800X	Mental Health Counselor	1509	MA
3	101YP2500X	Professional Counselor	1509	MA
4	101YS0200X	School Counselor	1509	MA
5	106H00000X	Marriage & Family Therapist	1509	MA
6	174400000X	Specialist

General Provider Information

NPI Number	:	1558538439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN DAVIS LMHC

Provider Business Mailing Address
First Line	:	12 GARNER ST
Second Line	:
City	:	NEWTON CENTRE
State	:	MA
Zip	:	02459-1610
Country	:	US
Telephone Number	:	617-733-7888
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 GARNER ST
Second Line	:
City	:	NEWTON CENTRE
State	:	MA
Zip	:	02459-1610
Country	:	US
Telephone Number	:	617-733-7888
Fax Number	:

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

Provider Enumeration Date	:	05/10/2008
Last Update Date	:	05/10/2008

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