Provider Demographics
NPI:1750730529
Name:MCWILLIAMS, MARY CATHERINE
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CATHERINE
Last Name:MCWILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 SW COMMONWEALTH RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2350
Mailing Address - Country:US
Mailing Address - Phone:908-809-2112
Mailing Address - Fax:
Practice Address - Street 1:1515 INDIAN RIVER BLVD
Practice Address - Street 2:STE A210
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5639
Practice Address - Country:US
Practice Address - Phone:772-774-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-12
Last Update Date:2016-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst