Provider Demographics
NPI:1174917934
Name:WILLIAMS, SAMUEL (LMSW)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:MR
Other - First Name:SAMUEL
Other - Middle Name:LEE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:2795 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5866
Mailing Address - Country:US
Mailing Address - Phone:718-761-9800
Mailing Address - Fax:718-370-1142
Practice Address - Street 1:2795 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5866
Practice Address - Country:US
Practice Address - Phone:718-761-9800
Practice Address - Fax:718-370-1142
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087085-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker