Provider Demographics
NPI:1699852673
Name:WILLIAMS, RAYMOND E (MSW)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21440 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1232
Mailing Address - Country:US
Mailing Address - Phone:718-279-0146
Mailing Address - Fax:
Practice Address - Street 1:3950 DOUGLASTON PKWY
Practice Address - Street 2:COUSELING OFFICE
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363-1542
Practice Address - Country:US
Practice Address - Phone:718-279-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRP020337-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY49078 21 80Medicare PIN