Healthcare Provider Details

I. General information

NPI: 1154614345
Provider Name (Legal Business Name): JAMIE T CARRENO DAVIDSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAIME T CARRENO PHD

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 JONES BRIDGE RD
BETHESDA MD
20814-4712
US

IV. Provider business mailing address

2480 LLEWELLYN AVE
FORT GEORGE G MEADE MD
20755-7081
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-3271
  • Fax:
Mailing address:
  • Phone: 301-677-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1729
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: