Provider Demographics
NPI:1306043328
Name:WILLIAMS, EDWARD NIMMER (LICSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:NIMMER
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 ELM ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2856
Mailing Address - Country:US
Mailing Address - Phone:617-522-2547
Mailing Address - Fax:
Practice Address - Street 1:40 DIMOCK ST
Practice Address - Street 2:METCO
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119
Practice Address - Country:US
Practice Address - Phone:617-427-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103172104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker