Provider Demographics
NPI:1013047547
Name:WILLIAMS, JANE E (LCSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 SAN PEDRO DR NE #A
Mailing Address - Street 2:
Mailing Address - City:ALBUGUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110
Mailing Address - Country:US
Mailing Address - Phone:505-265-0753
Mailing Address - Fax:505-268-5722
Practice Address - Street 1:1610 SAN PEDRO DR NE #A
Practice Address - Street 2:
Practice Address - City:ALBUGUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-265-0753
Practice Address - Fax:505-268-5722
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9924641041C0700X
NMC-097471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM45274746Medicaid
CO50926373Medicaid