Provider Demographics
NPI:1194763698
Name:DAVISON, JANICE (LCSW C)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:DAVISON
Suffix:
Gender:F
Credentials:LCSW C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 GODDARD PKWY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1126
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6960
Practice Address - Street 1:29520 CANVASBACK DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7124
Practice Address - Country:US
Practice Address - Phone:410-822-5007
Practice Address - Fax:410-822-5569
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0039OtherCAREFIRST BCBS FEDERAL
MD522156095OtherMHNET BEHAVIORAL HEALTH
MD609550002Medicaid
MD100085885OtherAPS HEALTHCARE
MD2173188OtherUNITED HEALTH CARE
MD522156095OtherUNITED BEHAVIORAL HEALTH
MD784751-000OtherMAGELLAN
MD880696OtherUNICARE/NCPPO
MD643331-05OtherCAREFRIST BCBS LOCAL
MD566LM391Medicare ID - Type Unspecified
MD609550002Medicaid