MEDICARE: MRS. JACQUELINE 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	LCS18556	CA
2	1041C0700X	Clinical Social Worker	LCSW-1650	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCS18556	OTHER	CA	LCSW

General Provider Information

NPI Number	:	1801985809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE WILLIAMS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1781
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85372-1781
Country	:	US
Telephone Number	:	949-636-3691
Fax Number	:	800-881-7511

Provider Business Practice Location Address
First Line	:	10000 N 31ST AVE
Second Line	:	SUITE C218
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9582
Country	:	US
Telephone Number	:	602-441-2388
Fax Number	:	800-881-7511

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	04/06/2017

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