Healthcare Provider Details

I. General information

NPI: 1538415781
Provider Name (Legal Business Name): KATRINA HULLER WILLIAMS LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 11/15/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 GOLDEN HILL LANE
KINGSTON NY
12401
US

IV. Provider business mailing address

PO BOX 337
PORT EWEN NY
12466-0337
US

V. Phone/Fax

Practice location:
  • Phone: 845-505-3480
  • Fax:
Mailing address:
  • Phone: 845-505-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0852951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: