Provider Demographics
NPI:1619004173
Name:WILLIAMS, KAREN P (PHD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:P
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 1:10737 LAUREL ST STE 230
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7659
Mailing Address - Country:US
Mailing Address - Phone:909-989-5556
Mailing Address - Fax:909-989-5558
Practice Address - Street 1:10737 LAUREL ST STE 230
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7659
Practice Address - Country:US
Practice Address - Phone:909-989-5556
Practice Address - Fax:909-989-5558
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12198103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABQ806YOtherMEDICARE ID TYPE UNSPECIFIED