Basic Information
| Provider Information | |||||||||
| NPI: | 1467625905 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | BIRNIE | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MSW, LICSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 SUGARLOAF ST UNIT B | ||||||||
| Address2: | |||||||||
| City: | SOUTH DEERFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013731144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135755372 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 270 BENTON DR | ||||||||
| Address2: | |||||||||
| City: | EAST LONGMEADOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010283233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135679993 | ||||||||
| FaxNumber: | 4132442650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2008 | ||||||||
| LastUpdateDate: | 11/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 122767 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.