Provider Demographics
NPI:1295888204
Name:DAVIDSON, FLORENCE HICKMAN (EDD)
Entity type:Individual
Prefix:DR
First Name:FLORENCE
Middle Name:HICKMAN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:MISS
Other - First Name:FLORENCE
Other - Middle Name:BUNTING
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:457 ELM RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2414
Mailing Address - Country:US
Mailing Address - Phone:508-548-5560
Mailing Address - Fax:508-548-5560
Practice Address - Street 1:457 ELM RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2414
Practice Address - Country:US
Practice Address - Phone:508-548-5560
Practice Address - Fax:508-548-5560
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1510103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO1964Medicare ID - Type Unspecified