| Debra L. Davis, Phd Limited Liability Company | |
|
179 Cedar Ln F Teaneck NJ 07666-4304 | |
| (201) 207-6294 | |
| (201) 690-6376 |
| Full Name | Debra L. Davis, Phd Limited Liability Company |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 179 Cedar Ln, Teaneck, New Jersey |
| Authorized Official Name and Position | Debra Lynnd Davis (OWNER) |
| Authorized Official Contact | 2012076294 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Debra L. Davis, Phd Limited Liability Company 10 Forest Ave Montvale NJ 07645-2205 Ph: (201) 207-6294 | Debra L. Davis, Phd Limited Liability Company 179 Cedar Ln F Teaneck NJ 07666-4304 Ph: (201) 207-6294 |
| NPI Number | 1730553579 |
|---|---|
| Provider Enumeration Date | 11/17/2015 |
| Last Update Date | 11/17/2015 |
| Medicare PECOS PAC ID | 8426358425 |
|---|---|
| Medicare Enrollment ID | O20151124000266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730553579 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 35SI00541200 (New Jersey) | Primary |
| Provider Name | Debra L Davis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942680020 PECOS PAC ID: 6507166501 Enrollment ID: I20151124000394 |
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