Provider Demographics
NPI:1275094211
Name:DAVIS, SHARON T (LCSW)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:T
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 1:15350 89TH AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3876
Mailing Address - Country:US
Mailing Address - Phone:646-523-9530
Mailing Address - Fax:
Practice Address - Street 1:15330 89TH AVE APT 405
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3872
Practice Address - Country:US
Practice Address - Phone:646-523-9530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0964191041C0700X
104100000X
NY105616104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical