Provider Demographics
NPI:1174958797
Name:JACQUELINE S WILLIAMS PSYCHOLOGIST INCORPORATED
Entity type:Organization
Organization Name:JACQUELINE S WILLIAMS PSYCHOLOGIST INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-224-3345
Mailing Address - Street 1:20720 VENTURA BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2306
Mailing Address - Country:US
Mailing Address - Phone:818-224-3345
Mailing Address - Fax:818-587-3353
Practice Address - Street 1:20720 VENTURA BLVD
Practice Address - Street 2:STE 210
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2306
Practice Address - Country:US
Practice Address - Phone:818-224-3345
Practice Address - Fax:818-587-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18937103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP18937Medicare PIN