Provider Demographics
NPI:1194047506
Name:WILLIAMS, DIEDRA
Entity type:Individual
Prefix:MS
First Name:DIEDRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CLINTON PLACE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801
Mailing Address - Country:US
Mailing Address - Phone:914-237-6089
Mailing Address - Fax:914-237-6099
Practice Address - Street 1:1 ODELL PLAZA
Practice Address - Street 2:FAMILY MATTERS PROGRAM OF WJCS
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-237-6089
Practice Address - Fax:914-237-6099
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator