Basic Information
| Provider Information | |||||||||
| NPI: | 1013480284 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | TAKEYA | ||||||||
| MiddleName: | MONNECK | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 213 S CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334093823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614711688 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 213 S CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334093823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618406106 | ||||||||
| FaxNumber: | 3052961530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2019 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.