Provider Demographics
NPI:1679993513
Name:DAVIDSON, DIANA (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:DAVIDSON
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 1:9100 SW 55TH CT
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5845
Mailing Address - Country:US
Mailing Address - Phone:305-297-9717
Mailing Address - Fax:
Practice Address - Street 1:2200 NW CORPORATE BLVD. SUITE 300
Practice Address - Street 2:RELATIONSHIP CENTER OF SOUTH FLORIDA
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-955-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6623103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist