Basic Information
| Provider Information | |||||||||
| NPI: | 1003135849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | DEANNA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 OLD ORANGEBURG RD | ||||||||
| Address2: | BUILDING #1, ORANGEBURG BILINGUAL CLINIC-ENGLISH/ASL | ||||||||
| City: | ORANGEBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453987076 | ||||||||
| FaxNumber: | 8453987056 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 OLD ORANGEBURG RD, BUILDING #1 | ||||||||
| Address2: | ORANGEBURG BILINGUAL CLINIC-ENGLISH/ASL, ROCKLAND PSYCH | ||||||||
| City: | ORANGEBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453591000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2010 | ||||||||
| LastUpdateDate: | 05/19/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 069777-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.