Healthcare Provider Details

I. General information

NPI: 1669765590
Provider Name (Legal Business Name): STEPHANIE WILLIAMS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8355 CHURCH ST
GILROY CA
95020-4406
US

IV. Provider business mailing address

PO BOX 657
GILROY CA
95021-0657
US

V. Phone/Fax

Practice location:
  • Phone: 408-359-6700
  • Fax:
Mailing address:
  • Phone: 408-359-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number006131
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY29189
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29189
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY29189
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY29189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: