Provider Demographics
NPI:1477634087
Name:WILLIAMSON, PHYLLIS N (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:N
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 HUNTSMAN DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-4652
Mailing Address - Country:US
Mailing Address - Phone:916-955-0670
Mailing Address - Fax:916-369-0670
Practice Address - Street 1:2609 CAPITOL AVE STE 6
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5904
Practice Address - Country:US
Practice Address - Phone:916-955-0670
Practice Address - Fax:916-369-0670
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12550103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL125500Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST
CAP00261110Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST
CAOPL125501Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST
CAOPL125502Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST