Healthcare Provider Details

I. General information

NPI: 1770783516
Provider Name (Legal Business Name): CHARLES WILLIMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 5TH AVE
NEW YORK NY
10029-3119
US

IV. Provider business mailing address

3 FORDHAM HILL OVAL APT 1H
BRONX NY
10468-4725
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073723-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: