Provider Demographics
NPI:1659818565
Name:WILLIAMS-MCDONALD, MYRTLE GAYLOR I
Entity Type:Individual
Prefix:MS
First Name:MYRTLE
Middle Name:GAYLOR
Last Name:WILLIAMS-MCDONALD
Suffix:I
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 1:21717 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1204
Mailing Address - Country:US
Mailing Address - Phone:347-512-1290
Mailing Address - Fax:
Practice Address - Street 1:21717 130TH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1204
Practice Address - Country:US
Practice Address - Phone:347-512-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician