Provider Demographics
NPI:1982863452
Name:WILLIAMS, FAE L (MSW, LCSW, SAC)
Entity Type:Individual
Prefix:MS
First Name:FAE
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW, LCSW, SAC
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW, SAC
Mailing Address - Street 1:10045 W LISBON AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2446
Mailing Address - Country:US
Mailing Address - Phone:414-358-7999
Mailing Address - Fax:414-358-7158
Practice Address - Street 1:10045 W LISBON AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-2446
Practice Address - Country:US
Practice Address - Phone:414-358-7999
Practice Address - Fax:414-358-7158
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1324-132101YA0400X
WI1935-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39338800Medicaid