Provider Demographics
NPI:1528255965
Name:DAVIS, STEVEN M (MS)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 NE 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2465
Mailing Address - Country:US
Mailing Address - Phone:480-203-9756
Mailing Address - Fax:
Practice Address - Street 1:1919 NE 45TH ST STE 221
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5136
Practice Address - Country:US
Practice Address - Phone:954-601-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13344101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health