Healthcare Provider Details

I. General information

NPI: 1740346253
Provider Name (Legal Business Name): TIMOTHY ALAN DAVIS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 05/16/2023
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 BUCKINGHAM DR
CHAMBERSBURG PA
17201-8370
US

IV. Provider business mailing address

164 BUCKINGHAM DR
CHAMBERSBURG PA
17201-8370
US

V. Phone/Fax

Practice location:
  • Phone: 171-738-5573
  • Fax:
Mailing address:
  • Phone: 717-385-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS016788
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS016788
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: