Healthcare Provider Details

I. General information

NPI: 1114831427
Provider Name (Legal Business Name): JALISA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 FAIRVIEW BLVD STE A
DELRAN NJ
08075-1475
US

IV. Provider business mailing address

1351 FAIRVIEW BLVD STE A
DELRAN NJ
08075-1475
US

V. Phone/Fax

Practice location:
  • Phone: 201-834-6789
  • Fax:
Mailing address:
  • Phone: 201-834-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07338100
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: