Individual provider Active NPI

Maureen Consuelo Davis, PSY D

  • Psychologist
  • Duarte, CA
National Provider Identifier
1679462675
Registry record updated Jul 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
4282 Issued in CA
Practice address
1401 Highland Ave
Duarte, CA 91010-2523
Phone
(657) 321-4000
NPI assigned
Jul 2, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
School Psychologist 103TS0200X 240250762 CA
Psychologist 103T00000X 4282 CA Primary

Addresses

Primary practice location

1401 Highland Ave
Duarte, CA 91010-2523

Mailing address

1128 Carmelita Cir
Monrovia, CA 91016-3710
Phone (415) 505-2615

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4282CAMDCounselor
240250762CAMDSchool Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1751414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1679462675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1128 CARMELITA CIR",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910163710",
            "telephone_number": "415-505-2615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 HIGHLAND AVE",
            "city": "DUARTE",
            "state": "CA",
            "postal_code": "910102523",
            "telephone_number": "657-321-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MAUREEN",
        "middle_name": "CONSUELO",
        "name_prefix": "Dr.",
        "credential": "PSY D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-02",
        "last_updated": "2025-07-02",
        "certification_date": "2025-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "CA",
            "license": "240250762",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "4282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duarte, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.