Provider Demographics
NPI:1780971671
Name:SUSAN C WILLIAMS,PHD,PA
Entity type:Organization
Organization Name:SUSAN C WILLIAMS,PHD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CRAVEN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-716-0757
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5815103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1780604736OtherNPI TYPE 1