Basic Information
| Provider Information | |||||||||
| NPI: | 1750410031 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | CLAUDIUS | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D., LCSWR, CASAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1368 | ||||||||
| Address2: | |||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119010951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317225657 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 CENTER DR | ||||||||
| Address2: | RIVERHEAD MENTAL HEALTH CLINIC-2ND FLOOR | ||||||||
| City: | RIVERHEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119013393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318521440 | ||||||||
| FaxNumber: | 6318521448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 09/13/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 9598 | NY | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | R047170-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.