Provider Demographics
NPI:1053164624
Name:WILLIAMS, CAROLYN RACHEL
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:RACHEL
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 1:95 WILCOX ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2161
Mailing Address - Country:US
Mailing Address - Phone:718-702-4725
Mailing Address - Fax:
Practice Address - Street 1:690 CASTLETON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1822
Practice Address - Country:US
Practice Address - Phone:718-876-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator