Provider Demographics
NPI:1831562255
Name:DAVIDSON, CARLENE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARLENE
Middle Name:
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 1:200 BLOOMFIELD AVE
Mailing Address - Street 2:300 HEBRON AVE. SUITE 217
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1545
Mailing Address - Country:US
Mailing Address - Phone:860-768-4025
Mailing Address - Fax:
Practice Address - Street 1:300 HEBRON AVE STE 217
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2192
Practice Address - Country:US
Practice Address - Phone:860-659-2697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent