Provider Demographics
NPI:1548325020
Name:DAVIS, JANE (MSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:B
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:14350 HOOVER AVE
Mailing Address - Street 2:APT 104
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2121
Mailing Address - Country:US
Mailing Address - Phone:718-657-6537
Mailing Address - Fax:718-657-6537
Practice Address - Street 1:11020 71ST RD
Practice Address - Street 2:ARISTA CENTER FOR PSYCHOTHERAPY
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4945
Practice Address - Country:US
Practice Address - Phone:718-793-3133
Practice Address - Fax:718-793-2023
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244826Medicaid
NY4156SGMedicare ID - Type Unspecified