Provider Demographics
NPI:1396113304
Name:DAVIS, BRIGID (LICSW)
Entity type:Individual
Prefix:
First Name:BRIGID
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EASTBROOK RD STE 104
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-2088
Mailing Address - Country:US
Mailing Address - Phone:781-329-9365
Mailing Address - Fax:781-302-4635
Practice Address - Street 1:20 EASTBROOK RD STE 104
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2088
Practice Address - Country:US
Practice Address - Phone:781-329-9365
Practice Address - Fax:781-302-4635
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA1262741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA99618201OtherNETWORK HEALTH
MA0000023532OtherBMC
MA1303287Medicaid
MA042611055OtherTAX ID
MA1004745OtherNHP
MA1303287OtherMBHP
MAM18633OtherBCBS
MA99618201OtherNETWORK HEALTH