Provider Demographics
NPI:1790963932
Name:WILLIAMS, JANE M
Entity Type:Individual
Prefix:PROF
First Name:JANE
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:M
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED DIETITIAN
Mailing Address - Street 1:600B PELHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805
Mailing Address - Country:US
Mailing Address - Phone:914-235-5047
Mailing Address - Fax:
Practice Address - Street 1:600 PELHAM RD # 600B
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-1328
Practice Address - Country:US
Practice Address - Phone:914-235-5047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002175320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities