Provider Demographics
NPI:1417350430
Name:STEPHANIE L. DAVIDSON, PSY.D., A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:STEPHANIE L. DAVIDSON, PSY.D., A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:805-405-6945
Mailing Address - Street 1:5743 CORSA AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6451
Mailing Address - Country:US
Mailing Address - Phone:805-405-6945
Mailing Address - Fax:805-426-8868
Practice Address - Street 1:5743 CORSA AVE STE 221
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-6451
Practice Address - Country:US
Practice Address - Phone:805-405-6945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-04
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24540103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty