Provider Demographics
NPI:1215052766
Name:DAVIS, KIMBERLY ALISO (LCSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ALISO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SAINT MARKS AVE
Mailing Address - Street 2:APT 3R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3417
Mailing Address - Country:US
Mailing Address - Phone:917-549-9268
Mailing Address - Fax:
Practice Address - Street 1:380 LAFAYETTE ST
Practice Address - Street 2:SUITE 201, ROOM 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6933
Practice Address - Country:US
Practice Address - Phone:917-549-9268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR057582-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical