Healthcare Provider Details

I. General information

NPI: 1841917101
Provider Name (Legal Business Name): LITAL DAVYDOV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 COLONY RD
NEW HAVEN CT
06511-1680
US

IV. Provider business mailing address

11702 CURZON RD APT 3
RICHMOND HILL NY
11418-3497
US

V. Phone/Fax

Practice location:
  • Phone: 929-377-3291
  • Fax:
Mailing address:
  • Phone: 929-377-3291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2380
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: