Glenn Williams

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

12 Southern Ave
Boston, MA 02124-2012

Phone

(617) 291-9667

NPI assigned

Jul 14, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fathers' Uplift Family Group, LLC

  • Clinical Social Worker
  • Dorchester, MA
  • NPI 1174975452
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1295307650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 SOUTHERN AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021242012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 SOUTHERN AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021242012",
            "telephone_number": "617-291-9667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "GLENN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-14",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH INSTITUTE",
            "identifier": "1174975452",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "glenn@fathersuplift.org",
            "affiliation": "N",
            "endpointDescription": "email address from employer",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "12 Southern Ave",
            "city": "Boston",
            "state": "MA",
            "country_code": "US",
            "postal_code": "021242012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elisha Williams, CPNP
• Elizabeth Nadeau Williams
• Ellen Kathleen Williams, MD
• Elliot Tyson Williams
• Erika Kristen Williams
• Gordon Harold Williams, MD
• Helen Florence Williams, NP
• Imani Williams
• Jennifer Williams, MB,BCH,BAO
• Jennifer Fox Williams, LCSW

• Community Health Worker in Boston, MA
• Providers in Boston, MA by specialty
• Community Health Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.