Individual
SUSAN DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
235 BLUE POINT AVE, BLUE POINT, NY 11715-1261
(631) 363-5794
Mailing address
30 ELIZABETH ST, PATCHOGUE, NY 11772-4028
(631) 960-4329
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
962902151
NY
Other
Enumeration date
09/06/2024
Last updated
09/06/2024
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