MEDICARE: LATOYA DAVIS BS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5EDBAC8A-FB98-495D-8	OTHER	MA	CANS

General Provider Information

NPI Number	:	1861707648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA DAVIS BS

Provider Business Mailing Address
First Line	:	5 HARTFORD CT
Second Line	:	APT # 1
City	:	DORCHESTER
State	:	MA
Zip	:	02125-2823
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 HARTFORD CT
Second Line	:	APT # 1
City	:	DORCHESTER
State	:	MA
Zip	:	02125-2823
Country	:	US
Telephone Number	:	617-794-7120
Fax Number	:

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

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	08/17/2010

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Directions to “ LATOYA DAVIS BS” Practice Location

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