Provider Demographics
NPI:1811264880
Name:WILLIAMS, SUSAN L (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
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 1:435 N. BEDFORD DRIVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4345
Mailing Address - Country:US
Mailing Address - Phone:310-271-7885
Mailing Address - Fax:310-271-7869
Practice Address - Street 1:435 N BEDFORD DR
Practice Address - Street 2:SUITE 309
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4321
Practice Address - Country:US
Practice Address - Phone:310-271-7885
Practice Address - Fax:310-271-7869
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical