Provider Demographics
NPI:1225875248
Name:WILLIAMS, TANNER KALEB (LMSW)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:KALEB
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CENTRAL PARK W APT 1U
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7214
Mailing Address - Country:US
Mailing Address - Phone:646-665-3390
Mailing Address - Fax:
Practice Address - Street 1:25 CENTRAL PARK W APT 1U
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7214
Practice Address - Country:US
Practice Address - Phone:646-665-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07146500104100000X
NY123909104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker