MEDICARE: MS. DANYELL KELLY WILLIAMS M.S.C.J.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	101YP1600X	Pastoral Counselor	PA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	PA
3	103K00000X	Behavior Analyst	PA

General Provider Information

NPI Number	:	1942736152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANYELL KELLY WILLIAMS M.S.C.J.

Provider Business Mailing Address
First Line	:	1647 N 60TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3908
Country	:	US
Telephone Number	:	267-972-5648
Fax Number	:

Provider Business Practice Location Address
First Line	:	1647 N 60TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3908
Country	:	US
Telephone Number	:	267-972-5648
Fax Number	:

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

Provider Enumeration Date	:	05/08/2017
Last Update Date	:	05/08/2017

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