Provider Demographics
NPI:1942680020
Name:DAVIS, DEBRA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:L
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 1:179 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4304
Mailing Address - Country:US
Mailing Address - Phone:201-207-6294
Mailing Address - Fax:201-907-0031
Practice Address - Street 1:179 CEDAR LANE
Practice Address - Street 2:SUITE C
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4304
Practice Address - Country:US
Practice Address - Phone:201-505-8972
Practice Address - Fax:201-596-3630
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00541200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical