Provider Demographics
NPI:1770707085
Name:WILLIAMS, PHYLLIS A (LCSW)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:PHYLLIS
Other - Middle Name:A
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:220 MONTGOMERY ST
Mailing Address - Street 2:APT. 4G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-2032
Mailing Address - Country:US
Mailing Address - Phone:718-735-7431
Mailing Address - Fax:718-613-4379
Practice Address - Street 1:INTERFAITH MEDICAL CENTER, CDOS
Practice Address - Street 2:1545 ATLANTIC AVE.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1166
Practice Address - Country:US
Practice Address - Phone:718-613-4447
Practice Address - Fax:718-613-4379
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075569-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical