MEDICARE: DARNELL 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	CW022663	PA

General Provider Information

NPI Number	:	1821737511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARNELL DAVIS LCSW

Provider Business Mailing Address
First Line	:	12450 PERRY HWY
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-7387
Country	:	US
Telephone Number	:	724-933-2961
Fax Number	:	724-933-4076

Provider Business Practice Location Address
First Line	:	12450 PERRY HWY
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-7387
Country	:	US
Telephone Number	:	724-933-2961
Fax Number	:	724-933-4076

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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