MEDICARE: MYRIAH DAVIS LMSW

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	31222	MD

General Provider Information

NPI Number	:	1891553004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRIAH DAVIS LMSW

Provider Business Mailing Address
First Line	:	2337 LEYTON CT
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-3703
Country	:	US
Telephone Number	:	540-760-9493
Fax Number	:

Provider Business Practice Location Address
First Line	:	2337 LEYTON CT
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-3703
Country	:	US
Telephone Number	:	540-760-9493
Fax Number	:

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

Provider Enumeration Date	:	03/12/2024
Last Update Date	:	03/12/2024

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