Provider Demographics
NPI:1114937638
Name:DAVIS, ROBERT W JR (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 SEVERN AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-7407
Mailing Address - Country:US
Mailing Address - Phone:504-889-1448
Mailing Address - Fax:504-885-8752
Practice Address - Street 1:3340 SEVERN AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-7407
Practice Address - Country:US
Practice Address - Phone:504-889-1448
Practice Address - Fax:504-885-8752
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA805103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1544051Medicaid
LAS59238Medicare UPIN
LA5X580D670Medicare PIN
LA5X580Medicare PIN