MEDICARE: JACQUELINE S WILLIAMS PSYCHOLOGIST INCORPORATED

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	103TC0700X	Clinical Psychologist	PSY 18937	CA

General Provider Information

NPI Number	:	1174958797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACQUELINE S WILLIAMS PSYCHOLOGIST INCORPORATED

Provider Business Mailing Address
First Line	:	20720 VENTURA BLVD
Second Line	:	STE 210
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2306
Country	:	US
Telephone Number	:	818-224-3345
Fax Number	:	818-587-3353

Provider Business Practice Location Address
First Line	:	20720 VENTURA BLVD
Second Line	:	STE 210
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2306
Country	:	US
Telephone Number	:	818-224-3345
Fax Number	:	818-587-3353

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACQUELINE S WILLIAMS
Credential	:	PHD
Telephone Number	:	818-224-3345

Provider Enumeration Date	:	09/13/2013
Last Update Date	:	12/16/2013

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