MEDICARE: CASSANDRA WILLIAMS PMHNP

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	163W00000X	Registered Nurse	691006	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	404549	NY

General Provider Information

NPI Number	:	1851796957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA WILLIAMS PMHNP

Provider Business Mailing Address
First Line	:	625 GRAMATAN AVE APT 5L
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10552-1817
Country	:	US
Telephone Number	:	347-264-7101
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 GRAMATAN AVE APT 5L
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10552-1817
Country	:	US
Telephone Number	:	347-264-7101
Fax Number	:

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

Provider Enumeration Date	:	10/31/2014
Last Update Date	:	11/21/2022

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