Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 069777-1 | NY |
NPI | 1003135849 |
---|---|
Provider Name | Ms. Kerry Deanna Davis |
First Address | Orangeburg, NY 10962 |
Second Address | Orangeburg, NY 10962 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2010 |
Last Update Date | 19/05/2010 |