Provider Demographics
NPI:1174823744
Name:DAVIDSON, CECELIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CECELIA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 MALCOLM X BLVD
Mailing Address - Street 2:APT. 3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2381
Mailing Address - Country:US
Mailing Address - Phone:914-912-2329
Mailing Address - Fax:
Practice Address - Street 1:3942 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2902
Practice Address - Country:US
Practice Address - Phone:347-398-8358
Practice Address - Fax:347-398-8359
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005806-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist