Provider Demographics
NPI:1679950745
Name:WILLIAMS, RACQUEL
Entity Type:Individual
Prefix:
First Name:RACQUEL
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 1:458 AUTUMN AVE
Mailing Address - Street 2:PH
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-2908
Mailing Address - Country:US
Mailing Address - Phone:347-806-0450
Mailing Address - Fax:
Practice Address - Street 1:2369 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3108
Practice Address - Country:US
Practice Address - Phone:212-876-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health