1841558988 NPI number — JACQUELINE L WILLIAMS, PHD, LMFT

Table of content: MIRNA LENNY QUIROGA LPC (NPI 1629500434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841558988 NPI number — JACQUELINE L WILLIAMS, PHD, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACQUELINE L WILLIAMS, PHD, LMFT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841558988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1540 INTERNATIONAL PKWY
Provider Second Line Business Mailing Address:
STE 2000
Provider Business Mailing Address City Name:
HEATHROW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32746-4713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-956-5773
Provider Business Mailing Address Fax Number:
407-536-5301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1540 INTERNATIONAL PKWY
Provider Second Line Business Practice Location Address:
STE 2000
Provider Business Practice Location Address City Name:
HEATHROW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-4713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-956-5773
Provider Business Practice Location Address Fax Number:
407-536-5301
Provider Enumeration Date:
04/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-956-5773

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MT 2384 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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