Provider Demographics
NPI:1477067817
Name:WILLIAMS, SHERIDAN JAMES II (CASAC-T)
Entity Type:Individual
Prefix:MR
First Name:SHERIDAN
Middle Name:JAMES
Last Name:WILLIAMS
Suffix:II
Gender:M
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5408
Mailing Address - Country:US
Mailing Address - Phone:845-562-2599
Mailing Address - Fax:845-562-4140
Practice Address - Street 1:280 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5408
Practice Address - Country:US
Practice Address - Phone:845-562-2599
Practice Address - Fax:845-562-4140
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33559101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)