MEDICARE: KIRA LYNNE DAVENPORT 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	075675	NY
2	1041C0700X	Clinical Social Worker	075675	NE

General Provider Information

NPI Number	:	1649825241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRA LYNNE DAVENPORT LCSW

Provider Business Mailing Address
First Line	:	163 STRAWTOWN RD
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-6830
Country	:	US
Telephone Number	:	845-638-8066
Fax Number	:

Provider Business Practice Location Address
First Line	:	163 STRAWTOWN RD
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-6830
Country	:	US
Telephone Number	:	845-638-8066
Fax Number	:

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

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	04/01/2025

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