Provider Demographics
NPI:1255697348
Name:MCWILLIAMS, KELLY A (LCSW)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:A
Last Name:MCWILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16E WALL ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3142
Mailing Address - Country:US
Mailing Address - Phone:203-500-9007
Mailing Address - Fax:
Practice Address - Street 1:16E WALL ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3142
Practice Address - Country:US
Practice Address - Phone:203-500-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT39601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical