Healthcare Provider Details

I. General information

NPI: 1851547442
Provider Name (Legal Business Name): KAREN DAVIDSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 CARLISLE BLVD NE
ALBUQUERQUE NM
87107-4565
US

IV. Provider business mailing address

2251 MONTEVINE CT SE
RIO RANCHO NM
87124-8867
US

V. Phone/Fax

Practice location:
  • Phone: 505-918-9291
  • Fax:
Mailing address:
  • Phone: 505-918-9291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number329574
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1282
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: