Provider Demographics
NPI:1518162569
Name:WILLIAMS, TED ALLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:ALLEN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 NW 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1618
Mailing Address - Country:US
Mailing Address - Phone:954-673-3201
Mailing Address - Fax:
Practice Address - Street 1:410 NW 74 AVE.
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1618
Practice Address - Country:US
Practice Address - Phone:954-673-3201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6960103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical