MEDICARE: TONYA WILLIAMS BASW,CDCA,CPRS, 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	171M00000X	Case Manager/Care Coordinator	LCDCIII.162423	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCIII.162423	OH
3	175T00000X	Peer Specialist	LCDCIII.162423	OH
4	104100000X	Social Worker	S.2005708	OH

General Provider Information

NPI Number	:	1306485214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA WILLIAMS BASW,CDCA,CPRS, LSW

Provider Business Mailing Address
First Line	:	PO BOX 932004
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2475 E 22ND ST FL 4
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-3209
Country	:	US
Telephone Number	:	216-363-2570
Fax Number	:

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

Provider Enumeration Date	:	12/26/2019
Last Update Date	:	10/10/2024

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