Provider Demographics
NPI:1154547628
Name:WILLIAMS, SARAH MONIQUE (PSY D)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:MONIQUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 S KIHEI RD APT 502
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7520
Mailing Address - Country:US
Mailing Address - Phone:773-919-6009
Mailing Address - Fax:773-334-6674
Practice Address - Street 1:1135 MAKAWAO AVE STE 102
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-7401
Practice Address - Country:US
Practice Address - Phone:773-919-6009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL07100669103TC0700X
HIPSY-1468103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH108317Medicare PIN