Provider Demographics
NPI:1265974315
Name:WILLIAMS, HERBERT (CASAC)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1506
Mailing Address - Country:US
Mailing Address - Phone:718-346-5900
Mailing Address - Fax:718-498-1718
Practice Address - Street 1:510 GATES AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1506
Practice Address - Country:US
Practice Address - Phone:718-346-5900
Practice Address - Fax:718-498-1718
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
161010577101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244931Medicaid
NYWX0421Medicare Oscar/Certification