Healthcare Provider Details

I. General information

NPI: 1528997459
Provider Name (Legal Business Name): DR. ALICIA NICOLE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 N 21ST ST
WHEATLEY HEIGHTS NY
11798-1847
US

IV. Provider business mailing address

167 N 21ST ST
WHEATLEY HEIGHTS NY
11798-1847
US

V. Phone/Fax

Practice location:
  • Phone: 631-491-1590
  • Fax:
Mailing address:
  • Phone: 631-491-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number002452-01
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number002452
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: