Provider Demographics
NPI:1720163835
Name:DAVIS, LEIF ERIKSEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEIF
Middle Name:ERIKSEN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7353 W SAND LAKE RD
Mailing Address - Street 2:STE 202
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5258
Mailing Address - Country:US
Mailing Address - Phone:407-351-5660
Mailing Address - Fax:407-363-6707
Practice Address - Street 1:7353 W SAND LAKE RD
Practice Address - Street 2:STE 202
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5258
Practice Address - Country:US
Practice Address - Phone:407-351-5660
Practice Address - Fax:407-363-6707
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6304103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC130867OtherVALUE OPTIONS ID
FL0001056461OtherMANAGED HEALTH NETWORK ID
FL1381886OtherAETNA ID
SC130867OtherVALUE OPTIONS ID