Susan C Williams,PHD,PA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY5815 Issued in FL

Legal business name

SUSAN C WILLIAMS,PHD,PA

Practice address

2107 Hendricks Ave Ste 2
Jacksonville, FL 32207-3370

Phone

(904) 716-0757

Fax

(904) 425-0028

NPI assigned

Jun 30, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan Craven Williams, PHDNPI 1780604736

Title

Psychologist

Phone

(904) 716-0757

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan C. Williams, PH.D.

  • Psychologist
  • Jacksonville, FL
  • NPI 1780604736
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673654400000",
    "number": "1780971671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2141 PARK ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043811",
            "telephone_number": "904-716-0757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2107 HENDRICKS AVE STE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322073370",
            "telephone_number": "904-716-0757",
            "fax_number": "904-425-0028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12058 San Jose Blvd Ste 602",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322238668",
            "country_code": "US",
            "telephone_number": "904-716-0757",
            "fax_number": "904-425-0028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUSAN C WILLIAMS,PHD,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-30",
        "last_updated": "2023-01-14",
        "certification_date": "2023-01-14",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "CRAVEN",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "904-716-0757",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY5815",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1780604736",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.