Provider Demographics
NPI:1649667924
Name:WILLIAMS, PAULA MARIE
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:2041 SEAGIRT BLVD
Mailing Address - Street 2:APT 3A
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5805
Mailing Address - Country:US
Mailing Address - Phone:917-302-9617
Mailing Address - Fax:
Practice Address - Street 1:2041 SEAGIRT BLVD
Practice Address - Street 2:APT 3A
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5805
Practice Address - Country:US
Practice Address - Phone:917-302-9617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093756-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker