Active NPI
Charlene Willams, CP
- Psychologist
- Los Angeles, CA
National Provider Identifier
1164637062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY15823
- Practice address
- 11726 San Vicente Blvd
Suite 680
Los Angeles, CA 90049 - Phone
- (310) 442-9286
- NPI assigned
- May 14, 2007
- Last updated
- May 7, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY15823 | CA | Primary |
| Clinical Psychologist | 103TC0700X | PSY15823 | CA | |
| Health Psychologist | 103TH0004X | PSY15823 | CA |
Addresses
Primary practice location
11726 San Vicente Blvd
Suite 680
Los Angeles, CA 90049
Mailing address
11726 San Vicente Blvd
Suite 680
Los Angeles, CA 90049
Phone (310) 442-9286
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY15823 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210118400000",
"number": "1164637062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11726 SAN VICENTE BLVD",
"address_2": "SUITE 680",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90049",
"telephone_number": "310-442-9286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11726 SAN VICENTE BLVD",
"address_2": "SUITE 680",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90049",
"telephone_number": "310-442-9286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLAMS",
"first_name": "CHARLENE",
"credential": "CP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-14",
"last_updated": "2008-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY15823",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY15823",
"primary": false
},
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": "CA",
"license": "PSY15823",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.