Provider Demographics
NPI:1447491311
Name:WILLIAMS, ISHMAN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ISHMAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PLEASANT HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2848
Mailing Address - Country:US
Mailing Address - Phone:617-372-7839
Mailing Address - Fax:
Practice Address - Street 1:6 PLEASANT ST STE 513
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5167
Practice Address - Country:US
Practice Address - Phone:617-372-7839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health