MEDICARE: MEREDITH DAVIDSON BCBA

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	101Y00000X	Counselor
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1679812150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH DAVIDSON BCBA

Provider Business Mailing Address
First Line	:	6511 15TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33702-7329
Country	:	US
Telephone Number	:	954-495-6033
Fax Number	:

Provider Business Practice Location Address
First Line	:	3258 PARKSIDE CENTER CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-0907
Country	:	US
Telephone Number	:	813-630-1746
Fax Number	:

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

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	08/15/2016

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