Provider Demographics
NPI:1174769244
Name:DAVIS, SUSAN W (LSCW-C)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LSCW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2362
Mailing Address - Country:US
Mailing Address - Phone:410-228-3825
Mailing Address - Fax:410-228-7916
Practice Address - Street 1:3 CEDAR ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2362
Practice Address - Country:US
Practice Address - Phone:410-228-3825
Practice Address - Fax:410-228-7916
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD052191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical