Provider Demographics
NPI:1316790942
Name:KRISTEN DAVIDSON, PSY.D., PLLC
Entity type:Organization
Organization Name:KRISTEN DAVIDSON, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:407-793-1282
Mailing Address - Street 1:13606 CASSIOPEIA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9310
Mailing Address - Country:US
Mailing Address - Phone:405-315-3070
Mailing Address - Fax:
Practice Address - Street 1:2497 WAVING MOSS WAY
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3041
Practice Address - Country:US
Practice Address - Phone:407-793-1282
Practice Address - Fax:833-895-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)