Provider Demographics
NPI:1013191279
Name:WILLIAMS, CAROLINE B (PHD, MP)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:B
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 CAMINITO SAN LUCAS
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-0404
Mailing Address - Country:US
Mailing Address - Phone:505-819-0859
Mailing Address - Fax:505-570-4560
Practice Address - Street 1:2204 BROTHERS RD
Practice Address - Street 2:STE B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6975
Practice Address - Country:US
Practice Address - Phone:505-819-0859
Practice Address - Fax:505-570-4560
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0911103TC0700X
NM20103TP0016X, 103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14880300Medicaid