Provider Demographics
NPI:1992883391
Name:DAVIS, MARY HARRISON (LCSWC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:HARRISON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 GODDARD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6362
Practice Address - Street 1:29520 CANVASBACK DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7124
Practice Address - Country:US
Practice Address - Phone:410-822-5007
Practice Address - Fax:410-822-5569
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD045891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD259147000OtherMAGELLAN GROUP
MD522156095OtherAMERICAN PSYCH SYSTEM
MD609550002Medicaid
MDLM49EAOtherCAREFIRST BCBS GROUP
MD0031OtherCAREFIRST BCBS FEDERAL
517251OtherUHC MAMSI GROUP
MD522156095OtherUNITED BEHAVIORAL HEALTH
DCR968OtherCAREFIRST FEDERAL GROUP
MD761936OtherNCPPO
MD892138-01OtherCAREFIRST BCBS
MD259147000OtherMAGELLAN GROUP