Provider Demographics
NPI:1578929386
Name:WILLIAMS, ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:WILLIAMS
Suffix:
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 1:24 NEAL RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4974
Mailing Address - Country:US
Mailing Address - Phone:207-892-1205
Mailing Address - Fax:
Practice Address - Street 1:24 NEAL RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4974
Practice Address - Country:US
Practice Address - Phone:207-892-1205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3439103T00000X
NH259 INACTIVE103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist