Basic Information
| Provider Information | |||||||||
| NPI: | 1104886084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIES | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | L.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 BRANDY ST | ||||||||
| Address2: | |||||||||
| City: | BOLTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060437602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606435699 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 71 HAYNES ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060404131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606461222 | ||||||||
| FaxNumber: | 8605333452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 000623 | CT | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.