Provider Demographics
NPI:1396937215
Name:DAVIS, NICOLE R (PSYD, JD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD, JD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:DAVIS
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, JD
Mailing Address - Street 1:2750 NE 185TH ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2876
Mailing Address - Country:US
Mailing Address - Phone:305-933-5733
Mailing Address - Fax:305-933-5233
Practice Address - Street 1:2750 NE 185TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2876
Practice Address - Country:US
Practice Address - Phone:305-933-5733
Practice Address - Fax:305-933-5233
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7520103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist