Healthcare Provider Details

I. General information

NPI: 1912050543
Provider Name (Legal Business Name): PATRICIA MARLENE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E DAKOTA AVE FL 2
FRESNO CA
93726-4804
US

IV. Provider business mailing address

2025 E DAKOTA AVE FL 2
FRESNO CA
93726-4804
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-5755
  • Fax:
Mailing address:
  • Phone: 559-453-5755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW23422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: