Basic Information
| Provider Information | |||||||||
| NPI: | 1477162121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | LUCIA | ||||||||
| MiddleName: | BELLINGER | ||||||||
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| Credential: | CASAC2 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 211 | ||||||||
| Address2: | |||||||||
| City: | NEW PALTZ | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125610211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9173590095 | ||||||||
| FaxNumber: | 5185141417 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 SCOFIELD ST | ||||||||
| Address2: | |||||||||
| City: | WALDEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125861710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457785628 | ||||||||
| FaxNumber: | 8457785168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2020 | ||||||||
| LastUpdateDate: | 07/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 24487 | 01 | NY | NYS OASAS | OTHER |