Healthcare Provider Details

I. General information

NPI: 1033795414
Provider Name (Legal Business Name): JESSICA WILLIAMS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 GRAND AVE
BALDWIN NY
11510-3148
US

IV. Provider business mailing address

362 CLIVE AVE
OCEANSIDE NY
11572-3405
US

V. Phone/Fax

Practice location:
  • Phone: 516-377-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110499
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: