MEDICARE: DR. ANNE DAVIDSON PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	019383	NY

General Provider Information

NPI Number	:	1336418896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE DAVIDSON PSY.D.

Provider Business Mailing Address
First Line	:	153 ROEBLING ST
Second Line	:	FOURTH FLOOR, SUITE 12
City	:	BROOKLYN
State	:	NY
Zip	:	11211-3363
Country	:	US
Telephone Number	:	347-469-1273
Fax Number	:

Provider Business Practice Location Address
First Line	:	153 ROEBLING ST
Second Line	:	FOURTH FLOOR, SUITE 12
City	:	BROOKLYN
State	:	NY
Zip	:	11211-3363
Country	:	US
Telephone Number	:	347-469-1273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2011
Last Update Date	:	10/06/2014

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