Provider Demographics
NPI:1235914466
Name:WILLIAMS, JUNETTE EBONE' (LMSW)
Entity Type:Individual
Prefix:
First Name:JUNETTE
Middle Name:EBONE'
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11826 194TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3422
Mailing Address - Country:US
Mailing Address - Phone:347-942-6343
Mailing Address - Fax:
Practice Address - Street 1:11826 194TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3422
Practice Address - Country:US
Practice Address - Phone:347-942-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115580-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker