Healthcare Provider Details

I. General information

NPI: 1700749314
Provider Name (Legal Business Name): DANIELLE WILLIAMS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WELD ST
DIXFIELD ME
04224
US

IV. Provider business mailing address

PO BOX 103
DIXFIELD ME
04224-0103
US

V. Phone/Fax

Practice location:
  • Phone: 207-217-4321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS1510
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: