MEDICARE: LAURA LEE 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	7714	CT

General Provider Information

NPI Number	:	1669755385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LEE DAVIS LCSW

Provider Business Mailing Address
First Line	:	40 FABER AVE
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06704-1829
Country	:	US
Telephone Number	:	203-748-5689
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 WEST ST
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-6531
Country	:	US
Telephone Number	:	203-748-5689
Fax Number	:

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

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/20/2011

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