Provider Demographics
NPI:1336493865
Name:DAVIS, STACI F (LMSW)
Entity type:Individual
Prefix:MS
First Name:STACI
Middle Name:F
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 LINDSEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:NY
Mailing Address - Zip Code:10511-1611
Mailing Address - Country:US
Mailing Address - Phone:845-705-7966
Mailing Address - Fax:
Practice Address - Street 1:475 WHITE PLAINS RD
Practice Address - Street 2:SUITE 11
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-5537
Practice Address - Country:US
Practice Address - Phone:845-705-7966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0836691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical