Healthcare Provider Details

I. General information

NPI: 1104333475
Provider Name (Legal Business Name): ELLEN WILLIAMS MSW, LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 HAMILTON AVE
SAN JOSE CA
95125-5425
US

IV. Provider business mailing address

1799 HAMILTON AVE
SAN JOSE CA
95125-5425
US

V. Phone/Fax

Practice location:
  • Phone: 888-530-4415
  • Fax:
Mailing address:
  • Phone: 888-530-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1802187
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2103070
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: