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NPI Code Detail

MEDICARE: SHANNON WILLIAMS

MEDICARE: SHANNON 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
11041C0700XClinical Social Worker9950CT

General Provider Information

NPI Number : 1508607706
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON WILLIAMS
Provider Business Mailing Address
First Line : 33 SHERBROOKE AVE
Second Line :
City : HARTFORD
State : CT
Zip : 06106-3839
Country : US
Telephone Number : 860-522-9296
Fax Number :
Provider Business Practice Location Address
First Line : 330 MARKET ST
Second Line :
City : HARTFORD
State : CT
Zip : 06120-2901
Country : US
Telephone Number : 860-522-9296
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2024
Last Update Date : 06/03/2024

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Directions to “ SHANNON WILLIAMS ” Practice Location

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