Provider Demographics
NPI:1073115986
Name:WILLIAMS, JERI
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DRURY LN
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-5961
Mailing Address - Country:US
Mailing Address - Phone:603-560-1148
Mailing Address - Fax:
Practice Address - Street 1:12 DRURY LN
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NH
Practice Address - Zip Code:03049-5961
Practice Address - Country:US
Practice Address - Phone:603-465-9182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH84737103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool