Healthcare Provider Details

I. General information

NPI: 1720766256
Provider Name (Legal Business Name): NIKKA WILLIAMS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17810 WEXFORD TER
JAMAICA NY
11432-3050
US

IV. Provider business mailing address

17010 130TH AVE APT 13C
JAMAICA NY
11434-3252
US

V. Phone/Fax

Practice location:
  • Phone: 718-658-1123
  • Fax:
Mailing address:
  • Phone: 917-250-3336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number119904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: