Provider Demographics
NPI:1073710455
Name:DAVIS, FRANK W JR (PHD)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:W
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 DWIGHT WAY STE C
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2639
Mailing Address - Country:US
Mailing Address - Phone:510-496-3470
Mailing Address - Fax:510-841-1252
Practice Address - Street 1:2000 DWIGHT WAY STE C
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2639
Practice Address - Country:US
Practice Address - Phone:510-496-3470
Practice Address - Fax:510-496-3470
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24164103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical