Provider Demographics
NPI:1184891897
Name:WILLIAMS-JENKINS, KIM DENISE (LCSWR,CASAC,CRC,MSED)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:DENISE
Last Name:WILLIAMS-JENKINS
Suffix:
Gender:F
Credentials:LCSWR,CASAC,CRC,MSED
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:DENISE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:15 1ST ST FL 2
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2201
Mailing Address - Country:US
Mailing Address - Phone:917-613-4009
Mailing Address - Fax:718-448-3571
Practice Address - Street 1:15 1ST ST FL 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2201
Practice Address - Country:US
Practice Address - Phone:917-613-4009
Practice Address - Fax:718-448-3571
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12039101YA0400X
NY077058-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY131623856OtherCEREBRAL PALSEY ASSOC NYS