Healthcare Provider Details

I. General information

NPI: 1316328180
Provider Name (Legal Business Name): MARYSA ROSE WILLIAMS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 DRESSLER RD NW
CANTON OH
44718-2546
US

IV. Provider business mailing address

4953 RIDGEWOOD CT APT C
STOW OH
44224
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-5155
  • Fax:
Mailing address:
  • Phone: 330-451-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: