Active NPI
Lydia Ann Williams, PH.D.
- Clinical Psychologist
- Mount Vernon, IL
National Provider Identifier
1184721110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071005322
- Practice address
- 4230 Lincolnshire Dr
Suite E
Mount Vernon, IL 62864-2189 - Phone
- (618) 242-4205
- Fax
- (618) 242-4209
- NPI assigned
- Sep 20, 2006
- 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 | 071005322 | IL | Primary |
Addresses
Primary practice location
4230 Lincolnshire Dr
Suite E
Mount Vernon, IL 62864-2189
Mailing address
4230 Lincolnshire Dr
Suite E
Mount Vernon, IL 62864-2189
Phone (618) 242-4205
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04132008 | Other | IL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- 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 |
|---|---|---|---|---|
| I20040708001378 | IL | Practitioner - Clinical Psychologist | 5294713004 | Practice locations: Mount Vernon, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
9 Cusumano Professional Plaza Dr
Mount Vernon, IL 62864
9 Cusumano Professional Plaza Dr
Mount Vernon, IL 62864-6736
Phone (618) 242-4205
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356998400000",
"number": "1184721110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4230 LINCOLNSHIRE DR",
"address_2": "SUITE E",
"city": "MOUNT VERNON",
"state": "IL",
"postal_code": "628642189",
"telephone_number": "618-242-4205",
"fax_number": "618-242-4209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4230 LINCOLNSHIRE DR",
"address_2": "SUITE E",
"city": "MOUNT VERNON",
"state": "IL",
"postal_code": "628642189",
"telephone_number": "618-242-4205",
"fax_number": "618-242-4209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "LYDIA",
"middle_name": "ANN",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2013-01-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071005322",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "04132008",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2013; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.