Provider Demographics
NPI:1952695066
Name:WILLIAMS, LETISHA R (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LETISHA
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 WYMAN ST
Mailing Address - Street 2:#1
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52 WYMAN ST
Practice Address - Street 2:#1
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-1509
Practice Address - Country:US
Practice Address - Phone:617-999-0985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1200901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical