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General NPI Number Information
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NPI Number | 1932781812
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Entity Type | Individual
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Provider Name | TERRY WILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 104 BLOOMFIELD AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4723
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Country | US
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Telephone | 973-783-6655
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Fax | 973-233-1396
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Provider Business Mailing Address
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Address Line | 309 E 22ND ST APT 7
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City | PATERSON
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State | NJ
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Zip | 07514-2247
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | POO559
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License Number State | NJ
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