Provider Demographics
NPI:1497033997
Name:DAVIS, ROBERT (PSYD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-0009
Mailing Address - Country:US
Mailing Address - Phone:413-444-0036
Mailing Address - Fax:413-584-3939
Practice Address - Street 1:8 RIVER DR
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-3540
Practice Address - Country:US
Practice Address - Phone:413-444-0036
Practice Address - Fax:413-584-3939
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7324103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical