Provider Demographics
NPI:1114038916
Name:WILLIAMSON, JEFFREY MICHAEL (PH D)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 N HARBOR CITY BLVD
Mailing Address - Street 2:STE 1D
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5764
Mailing Address - Country:US
Mailing Address - Phone:321-610-4703
Mailing Address - Fax:321-622-5948
Practice Address - Street 1:3700 N HARBOR CITY BLVD
Practice Address - Street 2:STE 1D
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5764
Practice Address - Country:US
Practice Address - Phone:321-610-4703
Practice Address - Fax:321-622-5948
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004728103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist