Provider Demographics
NPI:1063598613
Name:DAVIS, SANDRA A (LSW, PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 ELLSWORTH AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2851
Mailing Address - Country:US
Mailing Address - Phone:412-683-7702
Mailing Address - Fax:
Practice Address - Street 1:4716 ELLSWORTH AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2851
Practice Address - Country:US
Practice Address - Phone:412-683-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0122691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA58677OtherUNITED BEHAVIORAL HEALTH
PA707402OtherHIGHMARK