Individual
MATTHEW B DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
24 SAND BAR DR, BAYVILLE, NJ 08721-3548
(859) 379-9365
Mailing address
24 SAND BAR DR, BAYVILLE, NJ 08721-3548
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87-1155694
—
NJ
Enumeration date
06/11/2021
Last updated
06/11/2021
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