Provider Demographics
NPI:1265561492
Name:WILLIAMS, MARIA B (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:B
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 1:2820 UTAH ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3742
Mailing Address - Country:US
Mailing Address - Phone:505-238-5059
Mailing Address - Fax:
Practice Address - Street 1:ZUNI PUBLIC SCHOOL DISTRICT
Practice Address - Street 2:12 TWINBUTTES DR
Practice Address - City:ZUNI
Practice Address - State:NM
Practice Address - Zip Code:87327
Practice Address - Country:US
Practice Address - Phone:505-782-5511
Practice Address - Fax:505-782-5870
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
000T7568103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000T7568Medicaid