MEDICARE: MR. JOSEPH GARY WILLIAMS LSW

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	104100000X	Social Worker	SW132495	PA
2	1041C0700X	Clinical Social Worker	CW021410	PA
3	1041C0700X	Clinical Social Worker	44SC05947000	NJ

General Provider Information

NPI Number	:	1073999512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH GARY WILLIAMS LSW

Provider Business Mailing Address
First Line	:	5115 W DAKOTA ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2414
Country	:	US
Telephone Number	:	215-380-4282
Fax Number	:

Provider Business Practice Location Address
First Line	:	5115 W DAKOTA ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2414
Country	:	US
Telephone Number	:	215-380-4282
Fax Number	:

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

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	05/28/2024

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