Active NPI
Jessica Williams, PSY.D.
- Clinical Psychologist
- Moreno Valley, CA
National Provider Identifier
1063790483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY27548
- Practice address
- 13800 Heacock St
Suitc C230D
Moreno Valley, CA 92553-3339 - Phone
- (951) 421-5967
- NPI assigned
- Aug 2, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY27548 | CA | Primary |
Addresses
Primary practice location
13800 Heacock St
Suitc C230D
Moreno Valley, CA 92553-3339
Mailing address
13800 Heacock St Ste C230D
Moreno Valley, CA 92553-3339
Phone (951) 421-5967
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151119002658 | CA | Practitioner - Clinical Psychologist | 3678873817 | Practice locations: Moreno Valley, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY27548 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520380800000",
"number": "1063790483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13800 HEACOCK ST STE C230D",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925533339",
"telephone_number": "951-421-5967",
"fax_number": "951-823-5518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13800 HEACOCK ST",
"address_2": "SUITC C230D",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925533339",
"telephone_number": "951-421-5967"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "JESSICA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-02",
"last_updated": "2018-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY27548",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moreno Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.