MEDICARE: DANIELLE DAVENPORT LSW

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	104100000X	Social Worker	SW136622	PA

General Provider Information

NPI Number	:	1649900549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE DAVENPORT LSW

Provider Business Mailing Address
First Line	:	1600 N 18TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-3232
Country	:	US
Telephone Number	:	215-400-7310
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 N 18TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-3232
Country	:	US
Telephone Number	:	215-400-7310
Fax Number	:

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

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	06/14/2022

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Directions to “ DANIELLE DAVENPORT LSW” Practice Location

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