Provider Demographics
NPI:1285337055
Name:DAVIS, ARYIA TELPHA
Entity type:Individual
Prefix:
First Name:ARYIA
Middle Name:TELPHA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3380
Mailing Address - Country:US
Mailing Address - Phone:617-369-1556
Mailing Address - Fax:617-369-1556
Practice Address - Street 1:1640 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3380
Practice Address - Country:US
Practice Address - Phone:617-369-1556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator