Provider Demographics
NPI:1114348794
Name:CD PSYCHOLOGICAL PRACTICE, PA
Entity Type:Organization
Organization Name:CD PSYCHOLOGICAL PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-268-6600
Mailing Address - Street 1:118-35 QUEENS BLVD
Mailing Address - Street 2:SUITE 1403
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7205
Mailing Address - Country:US
Mailing Address - Phone:718-268-6600
Mailing Address - Fax:718-268-6065
Practice Address - Street 1:1937 GRACE AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7119
Practice Address - Country:US
Practice Address - Phone:239-340-5589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10313101YM0800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty