MEDICARE: MARY W DAVIS

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	101YP2500X	Professional Counselor	PC-0000192	DE

General Provider Information

NPI Number	:	1689735318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY W DAVIS

Provider Business Mailing Address
First Line	:	24 E 3RD ST
Second Line	:
City	:	NEW CASTLE
State	:	DE
Zip	:	19720-5006
Country	:	US
Telephone Number	:	610-363-1488
Fax Number	:	610-363-8273

Provider Business Practice Location Address
First Line	:	254 E MAIN ST
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19711-7311
Country	:	US
Telephone Number	:	610-363-1488
Fax Number	:	610-363-8273

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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Directions to “ MARY W DAVIS ” Practice Location

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