Healthcare Provider Details

I. General information

NPI: 1013191279
Provider Name (Legal Business Name): CAROLINE B WILLIAMS PH.D., M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 09/25/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BROOKE ARMY MEDICAL CENTER 3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

112 ESCALERA CIR
BOERNE TX
78006-2963
US

V. Phone/Fax

Practice location:
  • Phone: 706-304-3010
  • Fax: 800-866-8791
Mailing address:
  • Phone: 575-779-4401
  • Fax: 800-866-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0911
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number00911
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number20
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: