Provider Demographics
NPI:1548527989
Name:WILLIAMS, BREANNE ELAINE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:BREANNE
Middle Name:ELAINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 ANTARES RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1222
Mailing Address - Country:US
Mailing Address - Phone:505-977-1353
Mailing Address - Fax:
Practice Address - Street 1:805 TIJERAS AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3099
Practice Address - Country:US
Practice Address - Phone:505-242-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-096871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical