=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275801979
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBEKAH MARA WILLIAMS PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2011
-----------------------------------------------------
Last Update Date | 05/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 237 DELAWARE AVE STE 14&15
-----------------------------------------------------
City | OLEAN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14760-2601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-790-8847
-----------------------------------------------------
Fax | 716-526-4161
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1465 FOOTE AVENUE EXT
-----------------------------------------------------
City | JAMESTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14701-9383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-526-4041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SP0809X
-----------------------------------------------------
Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 1275801979
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 22 605850
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | F401628-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------