1336888262 NPI number — CAYLEE-MAE JEAN WILLLIAMS

Table of content: CAYLEE-MAE JEAN WILLLIAMS (NPI 1336888262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336888262 NPI number — CAYLEE-MAE JEAN WILLLIAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLLIAMS
Provider First Name:
CAYLEE-MAE
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1336888262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
724 SUNCREST LOOP APT 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASSELBERRY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32707-9036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-580-2550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
354 ENGLENOOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEBARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32713-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-635-1979
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , with the licence number:  RBT-22-218138 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RBT-22-218138 . This is a "BCAB" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 24657 . This is a "BOARD OF CLINICAL SOCIAL WORK, MARRIAGE & FAMILY THERAPY AND MENTAL HEALTH COUNS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 114447300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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