Provider Demographics
NPI:1992117626
Name:WILLIAMS, KRISTIN
Entity type:Individual
Prefix:
First Name:KRISTIN
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 1:502 COURT ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-4233
Mailing Address - Country:US
Mailing Address - Phone:315-733-1709
Mailing Address - Fax:315-733-1789
Practice Address - Street 1:502 COURT ST
Practice Address - Street 2:SUITE 401
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4233
Practice Address - Country:US
Practice Address - Phone:315-733-1709
Practice Address - Fax:315-733-1789
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72077812104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker