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General NPI Number Information
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NPI Number | 1720003056
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Entity Type | Individual
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Provider Name | MIRANDA B WILLIAMS PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 2271 ALPINE BLVD STE A
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City | ALPINE
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State | CA
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Zip | 91901-1101
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Country | US
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Telephone | 619-733-6472
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Fax | 619-448-0132
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Provider Business Mailing Address
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Address Line | 7290 NAVAJO RD STE 105
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City | SAN DIEGO
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State | CA
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Zip | 92119-1631
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Country | US
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Telephone | 619-733-6472
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Fax | 619-448-0132
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY 19618
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY19618
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License Number State | CA
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