MEDICARE: AUTUMN A 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
1	1041C0700X	Clinical Social Worker	I.2405908	OH

General Provider Information

NPI Number	:	1629682000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN A DAVIS LCSW

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5123 NORWICH ST STE 230
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-1493
Country	:	US
Telephone Number	:	216-468-5000
Fax Number	:

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

Provider Enumeration Date	:	09/03/2020
Last Update Date	:	05/27/2026

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