Provider Demographics
NPI:1285202341
Name:SCUDDER, DAVISHA CAMILLE
Entity Type:Individual
Prefix:
First Name:DAVISHA
Middle Name:CAMILLE
Last Name:SCUDDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RUMSEY RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1629
Mailing Address - Country:US
Mailing Address - Phone:914-980-9303
Mailing Address - Fax:
Practice Address - Street 1:220 RUMSEY RD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1629
Practice Address - Country:US
Practice Address - Phone:914-980-9303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11085101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor