Healthcare Provider Details

I. General information

NPI: 1710452198
Provider Name (Legal Business Name): AMY MARIE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PULLMAN ST BLDG B
LIVERMORE CA
94551-9756
US

IV. Provider business mailing address

300 PULLMAN ST BLDG B
LIVERMORE CA
94551-9756
US

V. Phone/Fax

Practice location:
  • Phone: 661-304-2510
  • Fax:
Mailing address:
  • Phone: 661-304-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW119444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: