Provider Demographics
NPI:1720003056
Name:WILLIAMS, MIRANDA B (PSYD)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:B
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MIRANDA
Other - Middle Name:B
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:7290 NAVAJO RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1631
Mailing Address - Country:US
Mailing Address - Phone:619-733-6472
Mailing Address - Fax:619-448-0132
Practice Address - Street 1:2271 ALPINE BLVD STE A
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-1101
Practice Address - Country:US
Practice Address - Phone:619-733-6472
Practice Address - Fax:619-448-0132
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19618103TC2200X
CAPSY19618103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent