Provider Demographics
NPI:1023762135
Name:WILLIAMS, KASMONE (CAT-LP)
Entity type:Individual
Prefix:
First Name:KASMONE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CAT-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 2ND AVE APT 25
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4115
Mailing Address - Country:US
Mailing Address - Phone:254-392-3847
Mailing Address - Fax:
Practice Address - Street 1:14 SYLVIA ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3723
Practice Address - Country:US
Practice Address - Phone:254-392-3847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113769221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist