Provider Demographics
NPI:1023335163
Name:WILLIAMS, JEANMARIE (RN, LMSW)
Entity type:Individual
Prefix:
First Name:JEANMARIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 STERLING ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2528
Mailing Address - Country:US
Mailing Address - Phone:631-804-5464
Mailing Address - Fax:
Practice Address - Street 1:176 STERLING ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2528
Practice Address - Country:US
Practice Address - Phone:631-804-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321208163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse