Provider Demographics
NPI:1467527341
Name:DAVIDSON, ASTRID (PSYD)
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7083
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-1083
Mailing Address - Country:US
Mailing Address - Phone:425-455-4890
Mailing Address - Fax:425-643-0352
Practice Address - Street 1:14042 NE 8TH ST STE 102
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4142
Practice Address - Country:US
Practice Address - Phone:425-455-4890
Practice Address - Fax:425-643-0352
Is Sole Proprietor?:No
Enumeration Date:2006-11-23
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002916103TC0700X
WALF00001471106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-2167622OtherTAX ID NUMBER
WA91-2167622OtherTAX ID NUMBER
WA8804551Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER