Provider Demographics
NPI:1548736598
Name:WILLIAMS, JACQUELINE ELAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ELAINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:752 PELHAM PARKWAY S APT 25
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462
Mailing Address - Country:US
Mailing Address - Phone:646-260-8831
Mailing Address - Fax:718-231-9184
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-8441
Practice Address - Fax:718-231-9187
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0747921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical