Provider Demographics
NPI:1760560072
Name:WILLIAMS, MARK E (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 EVANS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4654
Mailing Address - Country:US
Mailing Address - Phone:732-572-2662
Mailing Address - Fax:
Practice Address - Street 1:32 EVANS RIDGE RD # 2
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4654
Practice Address - Country:US
Practice Address - Phone:207-572-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJLC00061300101YA0400X
MELC147501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
001069PSYMedicare ID - Type Unspecified