Provider Demographics
NPI:1730330952
Name:WILLIAMS, BLENDA D (MSW)
Entity type:Individual
Prefix:MRS
First Name:BLENDA
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:BLENDA
Other - Middle Name:DELORIS
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC
Mailing Address - Street 1:151 STORRS RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1638
Mailing Address - Country:US
Mailing Address - Phone:860-465-5960
Mailing Address - Fax:860-465-0021
Practice Address - Street 1:151 STORRS RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1638
Practice Address - Country:US
Practice Address - Phone:860-465-5960
Practice Address - Fax:860-482-2638
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000483101YM0800X
CT001119101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001119Medicare PIN