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General NPI Number Information
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NPI Number | 1902763915
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Entity Type | Organization
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Legal Business Name | LIVED EXPERIENCE THERAPISTS, LCSW PLLC
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 9711 SPRINGFIELD BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429-1328
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Country | US
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Telephone | 718-749-2596
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Fax |
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Provider Business Mailing Address
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Address Line | 97-11 SPRINGFIELD BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429
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Country | US
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Telephone | 718-749-2596
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. JOSEPH DEVAUGHN WILLIAMS
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Credential | DSW, LCSW
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Telephone | 718-749-2596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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