Provider Demographics
NPI:1487182119
Name:WILLIAMS, THEODORE III (PHD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:WILLIAMS
Suffix:III
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 1:744 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3005
Mailing Address - Country:US
Mailing Address - Phone:772-223-9988
Mailing Address - Fax:
Practice Address - Street 1:744 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3005
Practice Address - Country:US
Practice Address - Phone:772-223-9988
Practice Address - Fax:772-223-9988
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5917103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist