MEDICARE: JESSICA WILLIAMS LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	101841	NY

General Provider Information

NPI Number	:	1033795414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WILLIAMS LMSW

Provider Business Mailing Address
First Line	:	362 CLIVE AVE
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-3405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 HOLLOW LN STE 301
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1215
Country	:	US
Telephone Number	:	516-207-7929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	01/08/2026

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