Provider Demographics
NPI:1770646879
Name:DAVIDGE, ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:DAVIDGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878
Mailing Address - Country:US
Mailing Address - Phone:401-624-9972
Mailing Address - Fax:401-624-1452
Practice Address - Street 1:2128 MAIN RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878
Practice Address - Country:US
Practice Address - Phone:401-624-9972
Practice Address - Fax:401-624-1452
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI413103T00000X
MA4373103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI3561Medicare ID - Type Unspecified