Provider Demographics
NPI:1407342389
Name:WILLIAMS, JAZMEN ERICKA
Entity Type:Individual
Prefix:
First Name:JAZMEN
Middle Name:ERICKA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 ANDREWS AVE APT 53
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-5940
Mailing Address - Country:US
Mailing Address - Phone:347-301-9845
Mailing Address - Fax:
Practice Address - Street 1:329 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5625
Practice Address - Country:US
Practice Address - Phone:347-301-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000000Medicaid