MEDICARE: MR. JAY ELI WILLIAMS ASW 27280

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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	ASW27280	CA

General Provider Information

NPI Number	:	1881880557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAY ELI WILLIAMS ASW 27280

Provider Business Mailing Address
First Line	:	2140 SHATTUCK AVE
Second Line	:	SUITE 711
City	:	BERKELEY
State	:	CA
Zip	:	94704-1210
Country	:	US
Telephone Number	:	510-841-1100
Fax Number	:	510-841-1101

Provider Business Practice Location Address
First Line	:	2140 SHATTUCK AVE
Second Line	:	SUITE 711
City	:	BERKELEY
State	:	CA
Zip	:	94704-1210
Country	:	US
Telephone Number	:	510-841-1100
Fax Number	:	510-841-1101

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

Provider Enumeration Date	:	09/17/2007
Last Update Date	:	12/13/2013

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