Provider Demographics
NPI:1497237747
Name:DAVIDSON, LAURA EMILY (EDS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:EMILY
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2319
Mailing Address - Country:US
Mailing Address - Phone:302-636-5681
Mailing Address - Fax:
Practice Address - Street 1:2916 DUNCAN RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2319
Practice Address - Country:US
Practice Address - Phone:302-636-5681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE96068103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE96068OtherDELAWARE DEPARTMENT OF EDUCATION