1790905503 NPI number — ANN CONANT DAVIES LCSW

Table of content: ANN CONANT DAVIES LCSW (NPI 1790905503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790905503 NPI number — ANN CONANT DAVIES LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIES
Provider First Name:
ANN
Provider Middle Name:
CONANT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790905503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 594
Provider Second Line Business Mailing Address:
19 JAY ST
Provider Business Mailing Address City Name:
PHOENICIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-579-5016
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 W 70TH
Provider Second Line Business Practice Location Address:
STE 1A
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-873-3422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TP0814X , with the licence number:  R0326211 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 104100000X , with the licence number: R0326211 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01693892 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com