MEDICARE: CAROL LEE WILLIAMS 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	1041C0700X	Clinical Social Worker	081962-1	NY

General Provider Information

NPI Number	:	1649560640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL LEE WILLIAMS LCSW

Provider Business Mailing Address
First Line	:	2023 ROUTE 9
Second Line	:
City	:	ROUND LAKE
State	:	NY
Zip	:	12151-1701
Country	:	US
Telephone Number	:	518-406-3119
Fax Number	:	518-406-3119

Provider Business Practice Location Address
First Line	:	2023 ROUTE 9
Second Line	:
City	:	ROUND LAKE
State	:	NY
Zip	:	12151-1701
Country	:	US
Telephone Number	:	518-406-3119
Fax Number	:	518-406-3119

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

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	02/01/2016

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