Provider Demographics
NPI:1801027495
Name:TANIA DAVIDSON PSYD A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:TANIA DAVIDSON PSYD A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:415-347-3438
Mailing Address - Street 1:1198 NAVIGATOR DR # 103
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4334
Mailing Address - Country:US
Mailing Address - Phone:805-320-5256
Mailing Address - Fax:805-339-0806
Practice Address - Street 1:200 TAMAL PLZ STE 130
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1195
Practice Address - Country:US
Practice Address - Phone:415-347-3438
Practice Address - Fax:805-339-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16510103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP16510Medicare PIN