Healthcare Provider Details

I. General information

NPI: 1043393432
Provider Name (Legal Business Name): MICHAEL D. WILLIAMS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 DEAN ST UNIT D
TAUNTON MA
02780-2782
US

IV. Provider business mailing address

3 SANDY HILL RD
MANSFIELD MA
02048-3246
US

V. Phone/Fax

Practice location:
  • Phone: 508-212-5730
  • Fax: 508-337-9338
Mailing address:
  • Phone: 508-212-5730
  • Fax: 508-337-9338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7469
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7469
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: