Active NPI
Ronnetta Williams, PHD
- Clinical Psychologist
- Palatka, FL
National Provider Identifier
1346500212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.009093
- Practice address
- 400 N State Road 19 Ste 48
Palatka, FL 32177-2449 - Phone
- (352) 281-9574
- NPI assigned
- May 24, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071.009093 | IL | Primary |
Addresses
Primary practice location
400 N State Road 19 Ste 48
Palatka, FL 32177-2449
Mailing address
400 N State Road 19 Ste 48
Palatka, FL 32177-2449
Phone (352) 281-9574
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 071.009093 | Other | IL | PROFESSIONAL LICENSE NUMBER |
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.009093 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633478400000",
"number": "1346500212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 N STATE ROAD 19 STE 48",
"city": "PALATKA",
"state": "FL",
"postal_code": "321772449",
"telephone_number": "352-281-9574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 N STATE ROAD 19 STE 48",
"city": "PALATKA",
"state": "FL",
"postal_code": "321772449",
"telephone_number": "352-281-9574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "RONNETTA",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-24",
"last_updated": "2021-10-06",
"certification_date": "2021-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.009093",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROFESSIONAL LICENSE NUMBER",
"identifier": "071.009093",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Palatka, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.