Provider Demographics
NPI:1952476947
Name:DAVIDSON, TANIA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:A
Last Name:DAVIDSON
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 1:1198 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 1:1198 NAVIGATOR DR # 103
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-4334
Practice Address - Country:US
Practice Address - Phone:805-628-2613
Practice Address - Fax:805-339-0806
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16510103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY016510Medicaid
CACP16510OtherMEDICARE PTAN