MEDICARE: CRYSTAL WILLIAMS MSW, LSW, LCSW

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	150.014112	IL
2	104100000X	Social Worker	149.019202	IL

General Provider Information

NPI Number	:	1366835316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL WILLIAMS MSW, LSW, LCSW

Provider Business Mailing Address
First Line	:	320 W 37TH ST FL 7
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-4289
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4309 S KING DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3308
Country	:	US
Telephone Number	:	773-451-1329
Fax Number	:

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

Provider Enumeration Date	:	03/16/2015
Last Update Date	:	08/11/2019

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