Basic Information
| Provider Information | |||||||||
| NPI: | 1194047506 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | DIEDRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 CLINTON PLACE | ||||||||
| Address2: | |||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142376089 | ||||||||
| FaxNumber: | 9142376099 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ODELL PLAZA | ||||||||
| Address2: | FAMILY MATTERS PROGRAM OF WJCS | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142376089 | ||||||||
| FaxNumber: | 9142376099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2010 | ||||||||
| LastUpdateDate: | 03/01/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.