MEDICARE: MR. WILLIE WILLIAMS JR. MSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1073884359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIE WILLIAMS JR. MSW

Provider Business Mailing Address
First Line	:	7275 PITTVILLE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-1526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7275 PITTVILLE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-1526
Country	:	US
Telephone Number	:	267-455-4407
Fax Number	:

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

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	01/19/2012

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