Provider Demographics
NPI:1508283672
Name:WILLIAMS, JASON ROBERT (LCSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 HIGHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:KY
Mailing Address - Zip Code:41016-1688
Mailing Address - Country:US
Mailing Address - Phone:502-229-3859
Mailing Address - Fax:859-727-6327
Practice Address - Street 1:503 WATSON RD
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1556
Practice Address - Country:US
Practice Address - Phone:859-835-2573
Practice Address - Fax:859-727-6327
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical