Provider Demographics
NPI:1861160004
Name:DAVIS, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COLONIAL VILLAGE DR APT 8
Mailing Address - Street 2:
Mailing Address - City:NORTH SWANZEY
Mailing Address - State:NH
Mailing Address - Zip Code:03431-4525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 NH ROUTE 12-A
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:NH
Practice Address - Zip Code:03602-0720
Practice Address - Country:US
Practice Address - Phone:603-855-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool