Provider Demographics
NPI:1306358510
Name:WILLIAMS, JEANETTE (MS, MFT)
Entity Type:Individual
Prefix:MISS
First Name:JEANETTE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 GRESHAM RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-2022
Mailing Address - Country:US
Mailing Address - Phone:908-251-2792
Mailing Address - Fax:
Practice Address - Street 1:1167 GRESHAM RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07062-2022
Practice Address - Country:US
Practice Address - Phone:908-251-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001415-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist