Provider Demographics
NPI:1902827355
Name:DAVIS, LORI B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W 82ND ST
Mailing Address - Street 2:SUITE P106
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5511
Mailing Address - Country:US
Mailing Address - Phone:212-580-0271
Mailing Address - Fax:
Practice Address - Street 1:107 W 82ND ST
Practice Address - Street 2:SUITE P106
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5511
Practice Address - Country:US
Practice Address - Phone:212-580-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015683103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV556A1Medicare ID - Type Unspecified