Provider Demographics
NPI:1124150586
Name:REITZEL WILLIAMS, ARLENE F (CLINCAL SOCIAL WORKE)
Entity type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:F
Last Name:REITZEL WILLIAMS
Suffix:
Gender:F
Credentials:CLINCAL SOCIAL WORKE
Other - Prefix:MRS
Other - First Name:ARLENE
Other - Middle Name:F
Other - Last Name:REITZEL WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CLINICAL SOCIAL WORK
Mailing Address - Street 1:38 PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1098
Mailing Address - Country:US
Mailing Address - Phone:631-758-7209
Mailing Address - Fax:631-758-7209
Practice Address - Street 1:38 PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1098
Practice Address - Country:US
Practice Address - Phone:631-758-7209
Practice Address - Fax:631-758-7209
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041699-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNB9391Medicare ID - Type Unspecified