Provider Demographics
NPI:1699745000
Name:WILLIAMS, PAUL D (PH D)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-0471
Mailing Address - Country:US
Mailing Address - Phone:860-928-5904
Mailing Address - Fax:860-928-0701
Practice Address - Street 1:5 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-2127
Practice Address - Country:US
Practice Address - Phone:860-928-5904
Practice Address - Fax:860-928-0701
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT80058OtherMANAGED HEALTH NETWORK
CT060001555CT01OtherBLUE CROSS
CT004095726Medicaid
CT133470OtherVALUE OPTIONS
680000091Medicare ID - Type Unspecified