Basic Information
| Provider Information | |||||||||
| NPI: | 1255832705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | AZARA | ||||||||
| MiddleName: | KAZIL | ||||||||
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| Credential: | RBT | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1532 SW MAPP RD | ||||||||
| Address2: | |||||||||
| City: | PALM CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349902446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612141518 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1532 SW MAPP RD | ||||||||
| Address2: | |||||||||
| City: | PALM CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349902446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612141518 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2018 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 106S00000X | N | 106S00000X | RBT-21-178666 | FL | Y |
ID Information
| ID | Type | State | Issuer | Description | 111379800 | 05 | FL | MEDICAID |