Provider Demographics
NPI:1336699529
Name:BASKERVILLE-WILLIAMS, KIRA (LCSW)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:BASKERVILLE-WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 MILLBURN AVE
Mailing Address - Street 2:STE D-2
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3725
Mailing Address - Country:US
Mailing Address - Phone:973-801-1801
Mailing Address - Fax:908-964-0809
Practice Address - Street 1:2130 MILLBURN AVE
Practice Address - Street 2:STE D-2
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3725
Practice Address - Country:US
Practice Address - Phone:973-801-1801
Practice Address - Fax:908-964-0809
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051897001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical