Provider Demographics
NPI:1891052577
Name:DAVIDSON, ROBERT (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BARTRAM MARKET DR STE 135-286
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4581
Mailing Address - Country:US
Mailing Address - Phone:904-827-3886
Mailing Address - Fax:844-380-4778
Practice Address - Street 1:155 BARTRAM MARKET DR STE 135-286
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-4581
Practice Address - Country:US
Practice Address - Phone:904-827-3886
Practice Address - Fax:844-380-4778
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4314103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst