Provider Demographics
NPI:1780604736
Name:WILLIAMS, SUSAN C (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
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 1:2141 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3811
Mailing Address - Country:US
Mailing Address - Phone:904-716-0757
Mailing Address - Fax:904-425-0028
Practice Address - Street 1:2107 HENDRICKS AVE STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3370
Practice Address - Country:US
Practice Address - Phone:904-716-0757
Practice Address - Fax:904-425-0028
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5815103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1078XMedicare ID - Type Unspecified