Provider Demographics
NPI:1548441629
Name:WILLIAMS, JOANNE S (MSW LCSW)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
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 1:151 KALMUS DR STE K1
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5975
Mailing Address - Country:US
Mailing Address - Phone:800-577-4701
Mailing Address - Fax:714-384-3875
Practice Address - Street 1:73345 HIGHWAY 111 STE 202
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3909
Practice Address - Country:US
Practice Address - Phone:760-340-3158
Practice Address - Fax:760-340-3197
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-17
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 224091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMMM00427MMedicare UPIN