Provider Demographics
NPI:1235928789
Name:WILLIAMS, JAMMIE (LBA)
Entity type:Individual
Prefix:
First Name:JAMMIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2114
Mailing Address - Country:US
Mailing Address - Phone:203-224-8957
Mailing Address - Fax:
Practice Address - Street 1:58 POMPERAUG RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3713
Practice Address - Country:US
Practice Address - Phone:203-725-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2121103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst