Provider Demographics
NPI:1104631530
Name:DAVIDSON, LISA (RBT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:DEMAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:741 G ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-4507
Mailing Address - Country:US
Mailing Address - Phone:443-848-7640
Mailing Address - Fax:
Practice Address - Street 1:741 G ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4507
Practice Address - Country:US
Practice Address - Phone:443-848-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT25410303106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician