Provider Demographics
NPI:1073999512
Name:WILLIAMS, JOSEPH GARY (LSW)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:GARY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 W DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2414
Mailing Address - Country:US
Mailing Address - Phone:215-380-4282
Mailing Address - Fax:
Practice Address - Street 1:5115 W DAKOTA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2414
Practice Address - Country:US
Practice Address - Phone:215-380-4282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132495104100000X
PACW0214101041C0700X
NJ44SC059470001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker