Stacy Lynn Davenport, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS 23732 Issued in CA

Practice address

500 Olive St
La Mesa, CA 95901

Phone

(916) 316-5041

Fax

(619) 825-8747

NPI assigned

Oct 3, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1275628893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8030 LA MESA BLVD # 211",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919420335",
            "telephone_number": "916-316-5041",
            "fax_number": "619-825-8747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 OLIVE ST",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "95901",
            "telephone_number": "916-316-5041",
            "fax_number": "619-825-8747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "STACY",
        "middle_name": "LYNN",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "LCS 23732",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 23732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Sue Dantes, PPS
• Codi Daoust
• Dap Health, Inc.
• Emily Denise Dascenzo, DPT
• Paul Edward Dato, M.D.
• Alexa Davidson
• Esther Davila, DO
• Jose Davila, M.D.
• Cheryl Davis Plotts, MFT PSYD
• Ingrid Davis, OTR/L

• Clinical Social Worker in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.