Provider Demographics
NPI:1679462675
Name:DAVIS, MAUREEN CONSUELO (PSY D)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:CONSUELO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 CARMELITA CIR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3710
Mailing Address - Country:US
Mailing Address - Phone:415-505-2615
Mailing Address - Fax:
Practice Address - Street 1:1401 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2523
Practice Address - Country:US
Practice Address - Phone:657-321-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240250762103TS0200X
CA4282103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool