Provider Demographics
NPI:1013305630
Name:WILLIAMS, JAHZIA ANDRE
Entity Type:Individual
Prefix:DR
First Name:JAHZIA
Middle Name:ANDRE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ANDRE
Other - Middle Name:JAHZIA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1548 FULTON ST # 3R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-5376
Mailing Address - Country:US
Mailing Address - Phone:646-474-2248
Mailing Address - Fax:
Practice Address - Street 1:1548 FULTON ST # 3R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-5376
Practice Address - Country:US
Practice Address - Phone:646-474-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY396183103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst