Healthcare Provider Details

I. General information

NPI: 1982372207
Provider Name (Legal Business Name): JEFFREY ST.JOHN WILLIAMS LCSW,MHRT/C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 151
BRADFORD ME
04410-0151
US

IV. Provider business mailing address

PO BOX 151
BRADFORD ME
04410-0151
US

V. Phone/Fax

Practice location:
  • Phone: 207-356-8264
  • Fax:
Mailing address:
  • Phone: 207-356-8264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC24525
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: