Provider Demographics
NPI:1326241670
Name:DAVIDOVICH, ROZALINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROZALINA
Middle Name:
Last Name:DAVIDOVICH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ROZ
Other - Middle Name:
Other - Last Name:DAVIDOVICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:102 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4309
Mailing Address - Country:US
Mailing Address - Phone:917-770-4909
Mailing Address - Fax:631-504-0277
Practice Address - Street 1:900 WALT WHITMAN RD STE 302
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2215
Practice Address - Country:US
Practice Address - Phone:917-770-4909
Practice Address - Fax:631-504-0277
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02878499Medicaid
NY02878499Medicaid