Provider Demographics
NPI:1538943196
Name:DAVIS, MARY LOUISE (LMSW)
Entity type:Individual
Prefix:
First Name:MARY LOUISE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ERIE CT
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1911
Mailing Address - Country:US
Mailing Address - Phone:607-661-5814
Mailing Address - Fax:
Practice Address - Street 1:9 ERIE CT
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1911
Practice Address - Country:US
Practice Address - Phone:607-661-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056425104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker