Basic Information
Provider Information
NPI: 1033243746
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: KAREN
MiddleName: DAYLE
NamePrefix: MRS.
NameSuffix:  
Credential: MFTI
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 353 BUNDY AVE APT 6
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951171636
CountryCode: US
TelephoneNumber: 3105616612
FaxNumber:  
Practice Location
Address1: 455 SILICON VALLEY BLVD
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951381858
CountryCode: US
TelephoneNumber: 4082849000
FaxNumber: 4082849010
Other Information
ProviderEnumerationDate: 03/15/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X  Y Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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