Provider Demographics
NPI:1356611313
Name:ROBERT C DAVISON PHD PSYCHOLOGY INC.
Entity type:Organization
Organization Name:ROBERT C DAVISON PHD PSYCHOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-288-0525
Mailing Address - Street 1:1439 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2228
Mailing Address - Country:US
Mailing Address - Phone:714-288-0525
Mailing Address - Fax:714-289-9008
Practice Address - Street 1:1439 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2228
Practice Address - Country:US
Practice Address - Phone:714-288-0525
Practice Address - Fax:714-289-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9478103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty