MEDICARE: ANTONIO WILLIAMS CADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	105223	NJ

General Provider Information

NPI Number	:	1043175961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO WILLIAMS CADC

Provider Business Mailing Address
First Line	:	601 RIDGE HILL BLVD
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10710-7738
Country	:	US
Telephone Number	:	929-669-1904
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 PAVONIA AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2920
Country	:	US
Telephone Number	:	833-671-2579
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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