Provider Demographics
NPI:1609324094
Name:WILLIAMS, STACEYANN
Entity Type:Individual
Prefix:
First Name:STACEYANN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 BRONX RIVER RD APT 12E
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-2575
Mailing Address - Country:US
Mailing Address - Phone:347-490-6515
Mailing Address - Fax:
Practice Address - Street 1:541 BRONX RIVER RD APT 12E
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-2575
Practice Address - Country:US
Practice Address - Phone:347-490-6515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst