Provider Demographics
NPI:1215084231
Name:WILLIAMS, JULIET (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIET
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NESCONSET HWY.
Mailing Address - Street 2:STONY BROOK MEDICAL PARK, BLDG 5D
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-941-3700
Mailing Address - Fax:631-754-1642
Practice Address - Street 1:2500 NESCONSET HWY.
Practice Address - Street 2:STONY BROOK MEDICAL PARK, BLDG 5D
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790
Practice Address - Country:US
Practice Address - Phone:631-941-3700
Practice Address - Fax:631-754-1642
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014327103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVS0541Medicare ID - Type Unspecified