MEDICARE: JACQUELINE L WILLIAMS

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	106H00000X	Marriage & Family Therapist	MT 2384	FL

General Provider Information

NPI Number	:	1447493192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE L WILLIAMS

Provider Business Mailing Address
First Line	:	3599 W LAKE MARY BLVD
Second Line	:	SUITE B
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3417
Country	:	US
Telephone Number	:	407-956-5773
Fax Number	:

Provider Business Practice Location Address
First Line	:	3599 W LAKE MARY BLVD
Second Line	:	SUITE B
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3417
Country	:	US
Telephone Number	:	407-956-5773
Fax Number	:

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

Provider Enumeration Date	:	04/10/2009
Last Update Date	:	03/28/2014

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Directions to “ JACQUELINE L WILLIAMS ” Practice Location

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