Provider Demographics
NPI:1962400093
Name:WILLIAMS, JODY STEELE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:STEELE
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 1:884 WALKER RD
Mailing Address - Street 2:SUITE 5C
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2758
Mailing Address - Country:US
Mailing Address - Phone:302-674-2199
Mailing Address - Fax:302-734-7780
Practice Address - Street 1:884 WALKER RD
Practice Address - Street 2:SUITE 5C
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2758
Practice Address - Country:US
Practice Address - Phone:302-674-2199
Practice Address - Fax:302-734-7780
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2007-07-09
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000647103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000022509Medicaid
DE1000022335Medicaid
DE1000022509Medicaid