Provider Demographics
NPI:1316996291
Name:VINCENT, JOY DAVIS
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:DAVIS
Last Name:VINCENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:A
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:8225 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-3016
Mailing Address - Country:US
Mailing Address - Phone:813-575-0570
Mailing Address - Fax:727-255-5900
Practice Address - Street 1:8225 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-3016
Practice Address - Country:US
Practice Address - Phone:813-575-0570
Practice Address - Fax:727-255-5900
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW95621041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8928444Medicaid
VA800002724Medicare ID - Type Unspecified
VAR60285Medicare UPIN