Healthcare Provider Details

I. General information

NPI: 1023249679
Provider Name (Legal Business Name): KATHRYN WILLIAMS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 4TH AVE STE 210
SAN DIEGO CA
92103-4237
US

IV. Provider business mailing address

1804 GARNET AVE # 419
SAN DIEGO CA
92109-3352
US

V. Phone/Fax

Practice location:
  • Phone: 619-347-0830
  • Fax:
Mailing address:
  • Phone: 619-347-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 22802
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY 22802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: