Provider Demographics
NPI:1609806553
Name:WILLIAMS, CAROL DENISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 391465
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94039-1465
Mailing Address - Country:US
Mailing Address - Phone:650-964-3230
Mailing Address - Fax:650-964-3230
Practice Address - Street 1:11711 PUTTER WAY
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6322
Practice Address - Country:US
Practice Address - Phone:650-964-3230
Practice Address - Fax:650-964-3230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY14211103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA129348Medicare UPIN