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NPI Code Detail

MEDICARE: DR. RICKEY WILLIAMSON PHD

MEDICARE: DR. RICKEY WILLIAMSON PHD
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
1103TC0700XClinical PsychologistPSY20072CA

General Provider Information

NPI Number : 1578619417
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICKEY WILLIAMSON PHD
Provider Business Mailing Address
First Line : 617 N MAR VISTA AVE APT 4
Second Line :
City : PASADENA
State : CA
Zip : 91106-1198
Country : US
Telephone Number : 626-796-2239
Fax Number :
Provider Business Practice Location Address
First Line : 8939 S SEPULVEDA BLVD STE 200
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-3667
Country : US
Telephone Number : 424-355-8717
Fax Number : 855-336-3013
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 06/18/2026

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Directions to “ DR. RICKEY WILLIAMSON PHD” Practice Location

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