| Davenport Holistic Healing And Wellness Llc | |
|
5 Burheight Gln Spencer NY 14883-9592 | |
| (607) 744-9438 | |
| Not Available |
| Full Name | Davenport Holistic Healing And Wellness Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5 Burheight Gln, Spencer, New York |
| Authorized Official Name and Position | Miranda Davenport (OWNER) |
| Authorized Official Contact | 6077449438 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Davenport Holistic Healing And Wellness Llc 5 Burheight Gln Spencer NY 14883-9592 Ph: (607) 744-9438 | Davenport Holistic Healing And Wellness Llc 5 Burheight Gln Spencer NY 14883-9592 Ph: (607) 744-9438 |
| NPI Number | 1699590307 |
|---|---|
| Provider Enumeration Date | 11/18/2024 |
| Last Update Date | 11/18/2024 |
| Certification Date | 11/18/2024 |
| Medicare PECOS PAC ID | 0648707521 |
|---|---|
| Medicare Enrollment ID | O20241217003762 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699590307 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Miranda Lynn Davenport |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548678972 PECOS PAC ID: 0244595304 Enrollment ID: I20180521002227 |
Blue Sky Center For Learning Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 303 Gunderman Rd, Spencer, NY 14883 Phone: 607-882-3219 |