Provider Demographics
NPI:1568887594
Name:HERCULES-WILLIAMS, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HERCULES-WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:JULIET
Other - Last Name:HERCULES-WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:60 CHARLES LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3653
Mailing Address - Country:US
Mailing Address - Phone:516-227-8689
Mailing Address - Fax:516-227-7149
Practice Address - Street 1:60 CHARLES LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3653
Practice Address - Country:US
Practice Address - Phone:516-227-8689
Practice Address - Fax:516-227-7149
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator