Provider Demographics
NPI:1033482633
Name:SUSAN L. WILLIAMS PHD. A PSYCHOLOGICAL CORP.
Entity Type:Organization
Organization Name:SUSAN L. WILLIAMS PHD. A PSYCHOLOGICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-271-7885
Mailing Address - Street 1:435 N BEDFORD DR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4321
Mailing Address - Country:US
Mailing Address - Phone:310-271-7885
Mailing Address - Fax:
Practice Address - Street 1:435 N BEDFORD DR
Practice Address - Street 2:SUITE 309
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4321
Practice Address - Country:US
Practice Address - Phone:310-271-7885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7566305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service