Provider Demographics
NPI:1053393256
Name:WILLIAMS, JOSEPH A (LCSW)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-3265
Mailing Address - Country:US
Mailing Address - Phone:270-247-5667
Mailing Address - Fax:888-706-9549
Practice Address - Street 1:209 E SUNSET DR
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-3265
Practice Address - Country:US
Practice Address - Phone:270-247-5667
Practice Address - Fax:888-706-9549
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11585430OtherCAQH
KYCSW0279Medicare PIN