Mark Henderson Davis, LICSW
Individual provider Active NPI Clinical Social Worker · Fridley, MN
NPI 1457786998 · NPPES record last updated Sep 3, 2013
Key facts
- NPI
- 1457786998
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 3796 (MN)
- Practice address
- 5384 Street NE
Community Options Fridley
Fridley, MN 55421 - Phone
- (763) 572-0004
- Fax
- (763) 572-1295
- NPI assigned
- Sep 3, 2013
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3796 | MN | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 3796 | MN | Yes |
Addresses
Primary practice location
5384 Street NE
Community Options Fridley
Fridley, MN 55421
Mailing address
5384 Street NE
Community Options Fridley
Fridley, MN 55421
Phone (763) 572-0004
Other providers in Fridley, MN
- Damasco
- Daniel R Baker MD PA
- Tasrina Dowla Dara
- Melisa Dawn Darling
- Huda Dahir Daud
- Valerie Luziel Davis
- Hamdi Dayib
- DBT Associates
- Bryan D Dejarlais
- Sheri Lynn Delich
All providers in Fridley, MN · Clinical Social Worker in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.