Provider Demographics
NPI:1023797966
Name:WILLIAMS, KADI-ANN (MD)
Entity type:Individual
Prefix:
First Name:KADI-ANN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COTTAGE PL
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1105
Mailing Address - Country:US
Mailing Address - Phone:516-710-3905
Mailing Address - Fax:
Practice Address - Street 1:1056 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3212
Practice Address - Country:US
Practice Address - Phone:631-656-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker