Provider Demographics
NPI:1801364492
Name:WILLIAMS, ROSEMARY SAMANTHA
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:SAMANTHA
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 1:1398 POCONO BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNT POCONO
Mailing Address - State:PA
Mailing Address - Zip Code:18344-1677
Mailing Address - Country:US
Mailing Address - Phone:646-673-1800
Mailing Address - Fax:
Practice Address - Street 1:1398 POCONO BLVD FL 2
Practice Address - Street 2:
Practice Address - City:MOUNT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344-1677
Practice Address - Country:US
Practice Address - Phone:646-673-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health