Provider Demographics
NPI:1043650062
Name:DAVIDSON, JOEL BRUCE (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:BRUCE
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MARTINE AVE
Mailing Address - Street 2:APT. 3E
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-3459
Mailing Address - Country:US
Mailing Address - Phone:914-949-2764
Mailing Address - Fax:
Practice Address - Street 1:555 W HARTSDALE AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1009
Practice Address - Country:US
Practice Address - Phone:914-948-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009855101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor