Provider Demographics
NPI:1871987016
Name:DAVIS, ALIZA D
Entity type:Individual
Prefix:
First Name:ALIZA
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALIZA
Other - Middle Name:D
Other - Last Name:FESSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:20 DELAFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-4800
Mailing Address - Country:US
Mailing Address - Phone:646-926-1830
Mailing Address - Fax:646-403-4618
Practice Address - Street 1:20 DELAFIELD WAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-4800
Practice Address - Country:US
Practice Address - Phone:646-926-1830
Practice Address - Fax:646-403-4618
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021060-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist