MEDICARE: MISS CAROL ANN WILLIAMS LPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	167G00000X	Licensed Psychiatric Technician	PT29591	CA

General Provider Information

NPI Number	:	1184745721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CAROL ANN WILLIAMS LPT

Provider Business Mailing Address
First Line	:	1532 DOUGLAS RD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-4113
Country	:	US
Telephone Number	:	209-951-3185
Fax Number	:

Provider Business Practice Location Address
First Line	:	4422 N PERSHING AVE
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-6954
Country	:	US
Telephone Number	:	209-953-8843
Fax Number	:	209-953-8478

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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