Individual provider Active NPI

Nikita Delane Williams, RADT

  • Social Worker
  • Berkeley, CA
National Provider Identifier
1417678756
Registry record updated Sep 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
13912 Issued in CA
Practice address
2975 Sacramento St
Berkeley, CA 94702-2534
Phone
(510) 644-0200
Fax
(510) 644-2044
NPI assigned
Sep 6, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 13912 CA Primary

Addresses

Primary practice location

2975 Sacramento St
Berkeley, CA 94702-2534

Mailing address

2975 Sacramento St
Berkeley, CA 94702-2534
Phone (510) 644-0200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
13912CAMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1417678756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 SACRAMENTO ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022534",
            "telephone_number": "510-644-0200",
            "fax_number": "510-644-2044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 SACRAMENTO ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022534",
            "telephone_number": "510-644-0200",
            "fax_number": "510-644-2044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "NIKITA",
        "middle_name": "DELANE",
        "credential": "RADT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-06",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "13912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; 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.