MEDICARE: DR. CARRON STEFFANIE WILLIAMS PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist
3	106H00000X	Marriage & Family Therapist	IMF 82898	CA
4	106H00000X	Marriage & Family Therapist	100016	CA

General Provider Information

NPI Number	:	1013079953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARRON STEFFANIE WILLIAMS PSYD

Provider Business Mailing Address
First Line	:	3200 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-5062
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-5062
Country	:	US
Telephone Number	:	562-427-6818
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	05/20/2020

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