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Individual

DR. LEIF ERIKSEN DAVIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PSYD

Contact information

Practice address
7353 W SAND LAKE RD, STE 202, ORLANDO, FL 32819-5258
(407) 351-5660
(407) 363-6707
Mailing address
7353 W SAND LAKE RD, STE 202, ORLANDO, FL 32819-5258
(407) 351-5660
(407) 363-6707

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY6304
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0001056461
MANAGED HEALTH NETWORK ID
FL
01
130867
VALUE OPTIONS ID
SC
01
1381886
AETNA ID
FL
Enumeration date
10/26/2006
Last updated
07/08/2007
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