Provider Demographics
NPI:1912986050
Name:DAVIDSON, MAURIE C (MSW)
Entity Type:Individual
Prefix:MS
First Name:MAURIE
Middle Name:C
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4691 ALONZO AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4374
Mailing Address - Country:US
Mailing Address - Phone:818-705-5979
Mailing Address - Fax:
Practice Address - Street 1:18401 BURBANK BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2822
Practice Address - Country:US
Practice Address - Phone:818-881-6445
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS23991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550010001292OtherPACIFICCARE BEHAVORIAL HE
CALCS2399OtherLICENSE NUMBER
CA58443998OtherUNITED BEHAVORIAL HEALTH
CAZZZZ19764ZOtherBLUE SHIELD
CAA855547OtherVALUE OPTIONS
CAA855547OtherVALUE OPTIONS