MEDICARE: MICHELLE LYNN WILLIAMS

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	101YM0800X	Mental Health Counselor	044529-1	NY
2	1041C0700X	Clinical Social Worker	090422-01	NY

General Provider Information

NPI Number	:	1497790521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LYNN WILLIAMS

Provider Business Mailing Address
First Line	:	9646 DUNBAR RD
Second Line	:
City	:	CAMDEN
State	:	NY
Zip	:	13316-5902
Country	:	US
Telephone Number	:	315-385-9367
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 MAIN ST
Second Line	:
City	:	CAMDEN
State	:	NY
Zip	:	13316-1302
Country	:	US
Telephone Number	:	315-335-9727
Fax Number	:

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	08/11/2023

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