Provider Demographics
NPI:1669938155
Name:WILLIAMS, TESSA K
Entity type:Individual
Prefix:MRS
First Name:TESSA
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TESSA
Other - Middle Name:K
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:13 ROBERT AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1920
Mailing Address - Country:US
Mailing Address - Phone:646-775-8202
Mailing Address - Fax:
Practice Address - Street 1:13 ROBERT AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1920
Practice Address - Country:US
Practice Address - Phone:646-775-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084671104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker