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NPI Code Detail

MEDICARE: AMY LIESELOTTE KAELEHIWA WILLIAMS M.F.T.

MEDICARE: AMY LIESELOTTE KAELEHIWA WILLIAMS M.F.T.
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
1106H00000XMarriage & Family TherapistMFC 35464CA

General Provider Information

NPI Number : 1669535480
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY LIESELOTTE KAELEHIWA WILLIAMS M.F.T.
Provider Business Mailing Address
First Line : 624 CREE DR
Second Line :
City : SAN JOSE
State : CA
Zip : 95123-5535
Country : US
Telephone Number : 408-227-6190
Fax Number : 408-293-6188
Provider Business Practice Location Address
First Line : 1040 LINCOLN AVE
Second Line :
City : SAN JOSE
State : CA
Zip : 95125-3150
Country : US
Telephone Number : 408-293-4489
Fax Number : 408-293-6188
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2006
Last Update Date : 07/08/2007

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