Provider Demographics
NPI:1740738749
Name:WILLIAMS, CLAIRENETTE I
Entity Type:Individual
Prefix:MISS
First Name:CLAIRENETTE
Middle Name:
Last Name:WILLIAMS
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 1:142 CEDAR HILL AVE
Mailing Address - Street 2:UNIT 2L
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2708
Mailing Address - Country:US
Mailing Address - Phone:203-745-1863
Mailing Address - Fax:203-498-7670
Practice Address - Street 1:142 CEDAR HILL AVE
Practice Address - Street 2:UNIT 2L
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2708
Practice Address - Country:US
Practice Address - Phone:203-745-1863
Practice Address - Fax:203-498-7670
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0001178302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization