Provider Demographics
NPI:1861707648
Name:DAVIS, LATOYA (BS)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HARTFORD CT
Mailing Address - Street 2:APT # 1
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 HARTFORD CT
Practice Address - Street 2:APT # 1
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-2823
Practice Address - Country:US
Practice Address - Phone:617-794-7120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5EDBAC8A-FB98-495D-8OtherCANS