Provider Demographics
NPI:1871842179
Name:WILLIAMS, RUBY G (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RUBY
Middle Name:G
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:16 HEMLOCK CIR
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-4962
Mailing Address - Country:US
Mailing Address - Phone:914-736-1414
Mailing Address - Fax:914-668-0940
Practice Address - Street 1:9 W PROSPECT AVE
Practice Address - Street 2:309
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2018
Practice Address - Country:US
Practice Address - Phone:914-668-9124
Practice Address - Fax:914-668-0940
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02377441103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst