Provider Demographics
NPI:1629108535
Name:DAVIS, HAROLD B (PHD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 RIVERSIDE DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5323
Mailing Address - Country:US
Mailing Address - Phone:212-496-0127
Mailing Address - Fax:212-496-0127
Practice Address - Street 1:98 RIVERSIDE DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5323
Practice Address - Country:US
Practice Address - Phone:212-496-0127
Practice Address - Fax:212-496-0127
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0028371103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0049171OtherGHI BMP
NY144807OtherVALUE OPTIONS
NYV61131Medicare ID - Type Unspecified