MEDICARE: CARMON NACOLE WILLIAMS

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	111646	CA

General Provider Information

NPI Number	:	1124449426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMON NACOLE WILLIAMS

Provider Business Mailing Address
First Line	:	23638 NEWHALL AVE
Second Line	:	#6 424
City	:	NEWHALL
State	:	CA
Zip	:	91321
Country	:	US
Telephone Number	:	310-882-8121
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 CORPORATE POINTE
Second Line	:	300
City	:	CULVER CITY
State	:	CA
Zip	:	90230-7615
Country	:	US
Telephone Number	:	310-882-8121
Fax Number	:

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

Provider Enumeration Date	:	01/04/2014
Last Update Date	:	01/18/2024

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