Provider Demographics
NPI:1043393432
Name:WILLIAMS, MICHAEL D (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SANDY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-3246
Mailing Address - Country:US
Mailing Address - Phone:508-212-5730
Mailing Address - Fax:508-337-9338
Practice Address - Street 1:174 DEAN ST
Practice Address - Street 2:UNIT D
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2782
Practice Address - Country:US
Practice Address - Phone:508-212-5730
Practice Address - Fax:508-337-9338
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7469103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0596281Medicaid
MAW50763Medicare ID - Type Unspecified