Provider Demographics
NPI:1770166159
Name:WILLIAMS, SARAH JEAN (BSL)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W BROOKHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2234
Mailing Address - Country:US
Mailing Address - Phone:215-872-7840
Mailing Address - Fax:
Practice Address - Street 1:209 W BROOKHAVEN RD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2234
Practice Address - Country:US
Practice Address - Phone:215-872-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health