MEDICARE: MS. JACQUELINE YVONNE WILLIAMS LCSW

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	SW5364	FL

General Provider Information

NPI Number	:	1316160005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE YVONNE WILLIAMS LCSW

Provider Business Mailing Address
First Line	:	3800 BIG BEND TRL
Second Line	:
City	:	POLK CITY
State	:	FL
Zip	:	33868-3001
Country	:	US
Telephone Number	:	863-984-6383
Fax Number	:	863-984-6383

Provider Business Practice Location Address
First Line	:	3800 BIG BEND TRL
Second Line	:
City	:	POLK CITY
State	:	FL
Zip	:	33868-3001
Country	:	US
Telephone Number	:	863-984-6383
Fax Number	:	863-984-6383

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	05/16/2008

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