Healthcare Provider Details

I. General information

NPI: 1811615032
Provider Name (Legal Business Name): MELISSA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 WEBSTER AVE APT 7A
BRONX NY
10467-5069
US

IV. Provider business mailing address

3160 WEBSTER AVE APT 7A
BRONX NY
10467-5069
US

V. Phone/Fax

Practice location:
  • Phone: 646-750-4684
  • Fax:
Mailing address:
  • Phone: 646-750-4684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1546028211
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: