Provider Demographics
NPI:1467506238
Name:DAVIDSON, KELLY BEST (LCSW, ITDS)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:BEST
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LCSW, ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 30TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-2065
Mailing Address - Country:US
Mailing Address - Phone:407-739-5355
Mailing Address - Fax:
Practice Address - Street 1:4151 6TH ST S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-3909
Practice Address - Country:US
Practice Address - Phone:727-893-2196
Practice Address - Fax:727-893-9152
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW129301041C0700X
FLDOE8835311041S0200X
171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811731400Medicaid