Provider Demographics
NPI:1104379346
Name:DAVILA, DEBORAH (MSED)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 RUNNING BROOK RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2010
Mailing Address - Country:US
Mailing Address - Phone:609-954-1266
Mailing Address - Fax:609-882-2835
Practice Address - Street 1:22 RUNNING BROOK RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-2010
Practice Address - Country:US
Practice Address - Phone:609-954-1266
Practice Address - Fax:609-882-2835
Is Sole Proprietor?:No
Enumeration Date:2016-07-23
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292015031103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool