Provider Demographics
NPI:1922156603
Name:DAVIS, MICHELE (PHD)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:DAVIS
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 1:41 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-2621
Mailing Address - Country:US
Mailing Address - Phone:917-922-5952
Mailing Address - Fax:
Practice Address - Street 1:59 SUNSET DR
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1559
Practice Address - Country:US
Practice Address - Phone:917-922-5952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011907103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080291OtherHEALTHNET
NY080291OtherHEALTHNET