Provider Demographics
NPI:1356661094
Name:WILLIAMS, MITCHELL (CASACT)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CASACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WISNER AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4519
Mailing Address - Country:US
Mailing Address - Phone:845-283-4417
Mailing Address - Fax:
Practice Address - Street 1:396 BROADWAY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1157
Practice Address - Country:US
Practice Address - Phone:845-794-8080
Practice Address - Fax:845-794-8343
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)