Provider Demographics
NPI:1154755403
Name:WILLIAMS, ERIC WENDELL JR
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:WENDELL
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2640
Mailing Address - Country:US
Mailing Address - Phone:347-463-0022
Mailing Address - Fax:
Practice Address - Street 1:48 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2640
Practice Address - Country:US
Practice Address - Phone:347-463-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor