1811075963 NPI number — JOYCE DAVIS LICSW

Table of content: JOYCE DAVIS LICSW (NPI 1811075963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811075963 NPI number — JOYCE DAVIS LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
JOYCE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1811075963
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:
57 LAKESIDE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH READING
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01864-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-664-8648
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH READING
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01864-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-664-2566
Provider Business Practice Location Address Fax Number:
978-664-8023
Provider Enumeration Date:
11/02/2006

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: 101YM0800X , with the licence number:  1019363 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 043114833-08 . This is a "PACIFICARE BEHAVIORAL HEA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 004071 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 004071 . This is a "VALUE OPTIONS (NY)" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 004071 . This is a "VALUE OPTIONS/GHI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P06072 . This is a "MEDEX" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P06072 . This is a "BCBS FEDERAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 730959 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 730959 . This is a "TUFTS BENEFIT ADMINIST" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P06072 . This is a "BCBS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2030824 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 730959 . This is a "TUFTS LIBERTY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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