MEDICARE: DR. ALICIA NICOLE DAVIS

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	106H00000X	Marriage & Family Therapist	002452-01	FL
2	106H00000X	Marriage & Family Therapist	002452	NY

General Provider Information

NPI Number	:	1528997459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA NICOLE DAVIS

Provider Business Mailing Address
First Line	:	167 N 21ST ST
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1847
Country	:	US
Telephone Number	:	631-491-1590
Fax Number	:

Provider Business Practice Location Address
First Line	:	167 N 21ST ST
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1847
Country	:	US
Telephone Number	:	631-491-1590
Fax Number	:

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

Provider Enumeration Date	:	05/16/2026
Last Update Date	:	05/16/2026

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