1861616179 NPI number — MR. DAVIS TAYLOR SHORT LCSW-C

Table of content: MR. DAVIS TAYLOR SHORT LCSW-C (NPI 1861616179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861616179 NPI number — MR. DAVIS TAYLOR SHORT LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHORT
Provider First Name:
DAVIS
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
M

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:
1861616179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1978
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21802-1978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-749-1015
Provider Business Mailing Address Fax Number:
410-749-0654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 N BOHEMIA AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CECILTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21913-0488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-458-2537
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007

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: 1041C0700X , with the licence number:  03268 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 119591300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com