Provider Demographics
NPI:1134360878
Name:WILLIAMSON, VANESSA (LISW)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:AGEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:900 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1109
Mailing Address - Country:US
Mailing Address - Phone:845-938-4114
Mailing Address - Fax:
Practice Address - Street 1:900 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1109
Practice Address - Country:US
Practice Address - Phone:458-938-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1450656104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101077Medicaid
OH060008OtherCERTIFICATION NUMBER
OHS.0901156Medicaid