=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528421229
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALENCIA WILLIAMS PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2016
-----------------------------------------------------
Last Update Date | 04/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4320 W MONTROSE AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60641-2016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-883-9100
-----------------------------------------------------
Fax | 773-883-0005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 405 N EUCLID AVE
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60302-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-665-5443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------