Provider Demographics
NPI:1629498605
Name:WILLIAMS, LIANA MARIE
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:MARIE
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 1:434 WARREN ST.
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02121
Mailing Address - Country:US
Mailing Address - Phone:617-989-0276
Mailing Address - Fax:617-989-0276
Practice Address - Street 1:434 WARREN ST.
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02121
Practice Address - Country:US
Practice Address - Phone:617-989-0276
Practice Address - Fax:617-989-0276
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst