Provider Demographics
NPI:1649560640
Name:WILLIAMS, CAROL LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12151-1701
Mailing Address - Country:US
Mailing Address - Phone:518-406-3119
Mailing Address - Fax:518-406-3119
Practice Address - Street 1:2023 ROUTE 9
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:NY
Practice Address - Zip Code:12151-1701
Practice Address - Country:US
Practice Address - Phone:518-406-3119
Practice Address - Fax:518-406-3119
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081962-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical