Provider Demographics
NPI:1295829208
Name:WILLIAMS, MARY ELLEN (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 OLIVER ST
Mailing Address - Street 2:SUITE W1A
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1446
Mailing Address - Country:US
Mailing Address - Phone:508-230-1732
Mailing Address - Fax:
Practice Address - Street 1:50 OLIVER ST
Practice Address - Street 2:SUITE W1A
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1446
Practice Address - Country:US
Practice Address - Phone:508-230-1732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1066661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical