Provider Demographics
NPI:1932331170
Name:WILLIAMS, BESSIE SOWELL (MANABER/MEMBCR)
Entity Type:Individual
Prefix:MS
First Name:BESSIE
Middle Name:SOWELL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MANABER/MEMBCR
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:152 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-3923
Mailing Address - Country:US
Mailing Address - Phone:203-909-6211
Mailing Address - Fax:203-507-7290
Practice Address - Street 1:152 EXCHANGE STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513
Practice Address - Country:US
Practice Address - Phone:203-909-6211
Practice Address - Fax:203-507-5290
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA0000368172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT374J00000XMedicaid