Healthcare Provider Details

I. General information

NPI: 1720003056
Provider Name (Legal Business Name): MIRANDA B WILLIAMS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRANDA B WILLIAMS PSYD

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 ALPINE BLVD STE A
ALPINE CA
91901-1101
US

IV. Provider business mailing address

7290 NAVAJO RD STE 105
SAN DIEGO CA
92119-1631
US

V. Phone/Fax

Practice location:
  • Phone: 619-733-6472
  • Fax: 619-448-0132
Mailing address:
  • Phone: 619-733-6472
  • Fax: 619-448-0132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 19618
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY19618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: