Provider Demographics
NPI:1174227664
Name:WILLIAMS, CARMEN IDALIA (BSW)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:IDALIA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67505-1820
Mailing Address - Country:US
Mailing Address - Phone:620-899-5709
Mailing Address - Fax:
Practice Address - Street 1:306 S ELM ST
Practice Address - Street 2:
Practice Address - City:SOUTH HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67505-1820
Practice Address - Country:US
Practice Address - Phone:620-899-5709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator