Provider Demographics
NPI:1861782369
Name:WILLIAMS, DEBORAH ANNE (RD,CDN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RD,CDN
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANNE
Other - Last Name:BERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CDN
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:NY
Mailing Address - Zip Code:11948
Mailing Address - Country:US
Mailing Address - Phone:631-252-4570
Mailing Address - Fax:
Practice Address - Street 1:369 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-1356
Practice Address - Country:US
Practice Address - Phone:631-363-4580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY978673133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered