Provider Demographics
NPI:1619001575
Name:WILLIAMS, MELVIN STANLEY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:STANLEY
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 1:1991 MCKEE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1406
Mailing Address - Country:US
Mailing Address - Phone:408-926-7950
Mailing Address - Fax:408-926-7949
Practice Address - Street 1:1991 MCKEE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1406
Practice Address - Country:US
Practice Address - Phone:408-926-7950
Practice Address - Fax:408-926-7949
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 88951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ24320ZMedicare ID - Type Unspecified
P69497Medicare UPIN