Provider Demographics
NPI:1730403205
Name:WILLIAMS, CARL (PHD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-1914
Mailing Address - Country:US
Mailing Address - Phone:860-456-3215
Mailing Address - Fax:860-423-3351
Practice Address - Street 1:1491 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1914
Practice Address - Country:US
Practice Address - Phone:860-456-3215
Practice Address - Fax:860-423-3351
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103-022101YM0800X
CT000953101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37LC0013400OtherADDICTIONS PROFESSIONAL LICENSE NUMBER
NJ103-022OtherPSYCHOLOGY INTERN PERMIT NUMBER