Kristen Davidson, PSY.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PY11597 Issued in FL

Practice address

3801 Avalon Park East Blvd Ste 200
Orlando, FL 32828-4902

Phone

(407) 793-1282

Fax

(833) 895-1282

NPI assigned

Jun 20, 2012

Last updated

Aug 31, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Kristen Domboski Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2023 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kristen Davidson, Psy.D., PLLC

  • Clinic/Center
  • Orlando, FL
  • NPI 1316790942
  NPD Authorized official
• Poyner Mental Health Services

  • Mental Health Counselor
  • Choctaw, OK
  • NPI 1740845361

  Single Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756598400000",
    "number": "1043573454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 AVALON PARK EAST BLVD STE 200",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328284902",
            "telephone_number": "407-793-1282",
            "fax_number": "833-895-1282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 AVALON PARK EAST BLVD STE 200",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328284902",
            "telephone_number": "407-793-1282",
            "fax_number": "833-895-1282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "KRISTEN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-20",
        "last_updated": "2025-08-31",
        "certification_date": "2025-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY11597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "DOMBOSKI",
            "prefix": "DR.",
            "credential": "PSY.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Abby Leigh Davidson, ARNP
• Denise Ann Davidson, M.A.
• Faith Davidson
• Jeffery Davidson, MS
• John William Davidson, LMT
• Marie Davidson, MS, ATC, LAT
• Jeffry Daviero
• Megan Davies
• Mary L Daviglus, M.D.,P.A.
• Lourdes Marie Davila Cruz

• Clinical Neuropsychologist in Orlando, FL
• Providers in Orlando, FL by specialty
• Clinical Neuropsychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.