Provider Demographics
NPI:1821087396
Name:WILLIAMS, DOUGLAS N (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:N
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 1:9 ELLSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:BROAD BROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06016-9682
Mailing Address - Country:US
Mailing Address - Phone:413-734-2676
Mailing Address - Fax:413-214-6400
Practice Address - Street 1:380 UNION ST
Practice Address - Street 2:SUITE 107
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4123
Practice Address - Country:US
Practice Address - Phone:413-734-2676
Practice Address - Fax:413-214-6400
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4546103TC0700X
CT002545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0524727Medicaid
MAW04380Medicare ID - Type UnspecifiedMEDICARE/BLUE CROSS