Provider Demographics
NPI:1235986050
Name:WILLIAMS, JOSEPH WALTER
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WALTER
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DRAKE ST # B228
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1362
Mailing Address - Country:US
Mailing Address - Phone:925-497-0671
Mailing Address - Fax:
Practice Address - Street 1:200 DRAKE ST # B228
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1362
Practice Address - Country:US
Practice Address - Phone:925-497-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty