Provider Demographics
NPI:1609093541
Name:WILLIAMS, SUSAN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:WILLIAMS
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 1:7720 NW 163RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-8408
Mailing Address - Country:US
Mailing Address - Phone:305-823-9144
Mailing Address - Fax:
Practice Address - Street 1:1695 NW 9TH AVE
Practice Address - Street 2:ROOM 2416
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1409
Practice Address - Country:US
Practice Address - Phone:305-355-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5783103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical