Provider Demographics
NPI:1528399094
Name:DAVIS, CINDY R
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 SE WHITMORE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4531
Mailing Address - Country:US
Mailing Address - Phone:772-359-4824
Mailing Address - Fax:
Practice Address - Street 1:365 SE WHITMORE DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4531
Practice Address - Country:US
Practice Address - Phone:772-359-4824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-23
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-09-6432OtherBCBA CERTIFICATION