Provider Demographics
NPI:1194785865
Name:DAVIES, ROGER R (SCD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:R
Last Name:DAVIES
Suffix:
Gender:M
Credentials:SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W FOSTER ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3810
Mailing Address - Country:US
Mailing Address - Phone:781-306-9095
Mailing Address - Fax:339-293-4299
Practice Address - Street 1:1 W FOSTER ST
Practice Address - Street 2:SUITE 10
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3810
Practice Address - Country:US
Practice Address - Phone:617-306-9095
Practice Address - Fax:339-293-4299
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3306103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03325Medicare ID - Type Unspecified