Provider Demographics
NPI:1053513317
Name:DAVILA, JOANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PSYCHOLOGY
Mailing Address - Street 2:SUNY STONY BROOK
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-2500
Mailing Address - Country:US
Mailing Address - Phone:631-632-7826
Mailing Address - Fax:
Practice Address - Street 1:79 CHRISTIAN AVE
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1201
Practice Address - Country:US
Practice Address - Phone:631-632-7826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013981103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical