Provider Demographics
NPI:1184109050
Name:DAVIS, BETH ROTNER (LICSW)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ROTNER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01342-0097
Mailing Address - Country:US
Mailing Address - Phone:413-695-7516
Mailing Address - Fax:
Practice Address - Street 1:104 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MA
Practice Address - Zip Code:01360-1022
Practice Address - Country:US
Practice Address - Phone:413-498-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10245461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical