MEDICARE: MS. PHYLLIS A 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	075569-1	NY

General Provider Information

NPI Number	:	1770707085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHYLLIS A WILLIAMS LCSW

Provider Business Mailing Address
First Line	:	220 MONTGOMERY ST
Second Line	:	APT. 4G
City	:	BROOKLYN
State	:	NY
Zip	:	11225-2032
Country	:	US
Telephone Number	:	718-735-7431
Fax Number	:	718-613-4379

Provider Business Practice Location Address
First Line	:	INTERFAITH MEDICAL CENTER, CDOS
Second Line	:	1545 ATLANTIC AVE.
City	:	BROOKLYN
State	:	NY
Zip	:	11213-1166
Country	:	US
Telephone Number	:	718-613-4447
Fax Number	:	718-613-4379

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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