Provider Demographics
NPI:1770054751
Name:WILLIAMS, CORI JAMAL (LICSW)
Entity type:Individual
Prefix:MR
First Name:CORI
Middle Name:JAMAL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7664 LEGACY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-5930
Mailing Address - Country:US
Mailing Address - Phone:857-829-3067
Mailing Address - Fax:
Practice Address - Street 1:7 CABOT PL STE 3B
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4631
Practice Address - Country:US
Practice Address - Phone:857-227-9101
Practice Address - Fax:833-553-4120
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical