Provider Demographics
NPI:1215360466
Name:WILLIAMS, ANNISTASIA ANNE
Entity Type:Individual
Prefix:
First Name:ANNISTASIA
Middle Name:ANNE
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 1:8810 178TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4683
Mailing Address - Country:US
Mailing Address - Phone:347-730-7521
Mailing Address - Fax:
Practice Address - Street 1:8810 178TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4683
Practice Address - Country:US
Practice Address - Phone:347-730-7521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker