Provider Demographics
NPI:1962544379
Name:DAVIS, KATHLEEN K (PHD, LICSW)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SKIPPER LN
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-1933
Mailing Address - Country:US
Mailing Address - Phone:508-237-9940
Mailing Address - Fax:
Practice Address - Street 1:165 KING'S HIGHWAY
Practice Address - Street 2:ROUTE 6A
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653
Practice Address - Country:US
Practice Address - Phone:508-237-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1139491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical