Provider Demographics
NPI:1891181368
Name:SOMERVILLE, WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:SOMERVILLE
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 1:1639 CENTRE ST # 141
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5335
Mailing Address - Country:US
Mailing Address - Phone:718-971-9731
Mailing Address - Fax:718-425-9862
Practice Address - Street 1:1639 CENTRE ST # 141
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5335
Practice Address - Country:US
Practice Address - Phone:718-594-2458
Practice Address - Fax:718-425-9862
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022436103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical