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General NPI Number Information
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NPI Number | 1952431363
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Entity Type | Individual
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Provider Name | SUSIE DAVIS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 3031 SOUTH VERMONT AVENUE
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City | LOS ANGELES
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State | CA
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Zip | 90007-3033
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Country | US
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Telephone | 323-766-2360
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Fax | 323-373-2445
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Provider Business Mailing Address
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Address Line | 815 N EL CENTRO AVE
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City | LOS ANGELES
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State | CA
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Zip | 90038-3805
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Country | US
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Telephone | 323-769-7120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY19405
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License Number State | CA
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