Healthcare Provider Details

I. General information

NPI: 1700433950
Provider Name (Legal Business Name): MS. KAMAL WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 ADAM CLAYTON POWELL JR BLVD
NEW YORK NY
10027-4990
US

IV. Provider business mailing address

590 AVENUE OF AMERICAS
NEW YORK NY
10011-9904
US

V. Phone/Fax

Practice location:
  • Phone: 212-553-6708
  • Fax:
Mailing address:
  • Phone: 917-485-7360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: