Provider Demographics
NPI:1003027970
Name:WILLIAMS, TED (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-1506
Mailing Address - Country:US
Mailing Address - Phone:954-491-6122
Mailing Address - Fax:954-491-6122
Practice Address - Street 1:4830 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-1506
Practice Address - Country:US
Practice Address - Phone:954-491-6122
Practice Address - Fax:954-491-6122
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW78171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical