Provider Demographics
NPI:1831123173
Name:STEPHEN P. DAVIS, PH.D., P.A.
Entity Type:Organization
Organization Name:STEPHEN P. DAVIS, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:772-398-1003
Mailing Address - Street 1:2400 SE MIDPORT RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-4823
Mailing Address - Country:US
Mailing Address - Phone:772-398-1003
Mailing Address - Fax:772-398-1772
Practice Address - Street 1:2400 SE MIDPORT RD
Practice Address - Street 2:SUITE 211
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-4823
Practice Address - Country:US
Practice Address - Phone:772-398-1003
Practice Address - Fax:772-398-1772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125175OtherVALUE OPTIONS
FL10745971OtherAETNA
FL82322OtherCIGNA
FLIP029180OtherMAGELLAN
FL82322OtherCIGNA
FLR28415Medicare UPIN