MEDICARE: STEPHANIE L. DAVIDSON, PSY.D., A PSYCHOLOGICAL CORPORATION

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	103T00000X	Psychologist	PSY24540	CA

General Provider Information

NPI Number	:	1417350430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE L. DAVIDSON, PSY.D., A PSYCHOLOGICAL CORPORATION

Provider Business Mailing Address
First Line	:	5743 CORSA AVE STE 221
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-6451
Country	:	US
Telephone Number	:	805-405-6945
Fax Number	:	805-426-8868

Provider Business Practice Location Address
First Line	:	5158 CLARETON DR UNIT 481
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91376-7030
Country	:	US
Telephone Number	:	805-405-6945
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHANIE DAVIDSON
Credential	:	PSY.D.
Telephone Number	:	805-405-6945

Provider Enumeration Date	:	10/04/2014
Last Update Date	:	06/25/2025

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