Healthcare Provider Details

I. General information

NPI: 1497608087
Provider Name (Legal Business Name): ALIDA DAVIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WATERS PL STE 310
BRONX NY
10461-2727
US

IV. Provider business mailing address

1200 WATERS PL STE 310
BRONX NY
10461-2727
US

V. Phone/Fax

Practice location:
  • Phone: 347-684-1038
  • Fax:
Mailing address:
  • Phone: 347-684-1038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number027767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: