Provider Demographics
NPI:1356316814
Name:CAROLINE B WILLIAMS PHD PC
Entity Type:Organization
Organization Name:CAROLINE B WILLIAMS PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-819-0859
Mailing Address - Street 1:2204 BROTHERS RD STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6975
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM911103TC0700X
NM20103TP0016X, 103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM21975264Medicaid
NM21975264Medicaid