Individual
TENEA CLAUDETTE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
122 CHESTNUT ST, SPRINGFIELD, MA 01103-1538
(857) 756-0313
Mailing address
122 CHESTNUT ST, SPRINGFIELD, MA 01103-1538
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MTN982371862
BLUE CROSS BLUE SHIELD
—
Enumeration date
10/25/2018
Last updated
10/25/2018
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