Provider Demographics
NPI:1912172289
Name:WILLIAMS, ANN BURDETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:BURDETTE
Last Name:WILLIAMS
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 1:182 E 79TH ST
Mailing Address - Street 2:SUITE A1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0492
Mailing Address - Country:US
Mailing Address - Phone:212-327-4241
Mailing Address - Fax:
Practice Address - Street 1:379 SACKETT ST
Practice Address - Street 2:APT. 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4703
Practice Address - Country:US
Practice Address - Phone:718-938-7937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-076090-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR-076090-1OtherNYSTATE DEPT. OF ED. LICENCE # R-076090-1