Provider Demographics
NPI:1508369240
Name:WILLIAMS, JANET LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:JANET
Other - Middle Name:LYNN
Other - Last Name:GOERTZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:4755 W. PECOS ROAD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339
Mailing Address - Country:US
Mailing Address - Phone:520-550-6422
Mailing Address - Fax:520-550-6033
Practice Address - Street 1:4577 W PECOS RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-9002
Practice Address - Country:US
Practice Address - Phone:520-550-6422
Practice Address - Fax:520-550-6033
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-13825104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35728OtherLICENSED BACHELOR SOCIAL WORKER