Healthcare Provider Details

I. General information

NPI: 1841492675
Provider Name (Legal Business Name): BRUCE WARREN WILLIAMS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 S LOS ROBLES AVE
PASADENA CA
91106-3716
US

IV. Provider business mailing address

897 S LOS ROBLES AVE
PASADENA CA
91106-3716
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-6455
  • Fax: 213-763-5636
Mailing address:
  • Phone: 626-792-6455
  • Fax: 213-763-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY12785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: