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FREDERICK WILLIS
NPI 1669194346
Peer Specialist in Bronx, NY

Active since September 19, 2022
3584 JEROME AVE, BRONX, NY 10467(718) 653-1537 Get Directions Write a Review

NPPES record last updated: September 19, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Frederick Willis NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FREDERICK WILLIS (NPI 1669194346) is an individual peer specialist in Bronx, New York, licensed in New York (4259) and active in the NPI registry since September 2022.

NPPES Registry Identity

NPI1669194346
Entity TypeIndividualMale
Primary Taxonomy175T00000X
Provider Legal NameFREDERICK WILLIS
Location Address3584 JEROME AVEBronx, NY 10467-1006
Mailing Address79 Glenridge RdGlenville, NY 12302-4523
Phone(718) 653-1537
Sole ProprietorNo
Enumeration DateSeptember 19, 2022
NPPES CertifiedSeptember 19, 2022
✔ NPI 1669194346 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
License✔ Licensed in NY · 4259
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
3584 JEROME AVE, Bronx, NY 10467
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Other Identifiers 1

Medicaid01420795NY

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VICTORIA R SMITH CASAC
Counselor (Addiction (Substance Use Disorder))
3584 JEROME AVE
BRONX, NY 10467
Bronx County (718) 653-1537
EULALIO FONTANEZ
Counselor (Addiction (Substance Use Disorder))
3584 JEROME AVE
BRONX, NY 10467
Bronx County (718) 653-1537
PAULINE CANNELLA
Counselor (Addiction (Substance Use Disorder))
3584 JEROME AVE
BRONX, NY 10467
Bronx County (718) 653-1537
ROSEMARIE ROSA
Counselor (Addiction (Substance Use Disorder))
3584 JEROME AVE
BRONX, NY 10467
Bronx County (718) 653-1537
PROGRESSIVE GASTROENTEROLOGY LLC
Internal Medicine (Gastroenterology)
3584 JEROME AVE
BRONX, NY 10467
Bronx County (718) 231-4440
MICHELE HENNESSY
Social Worker
3584 JEROME AVE
BRONX, NY 10467
Bronx County (715) 653-1537
ELENA DIAZ
Counselor (Addiction (Substance Use Disorder))
3584 JEROME AVE
BRONX, NY 10467
Bronx County (718) 653-1537
ANDY CRUZ
Counselor (Addiction (Substance Use Disorder))
3584 JEROME AVE
BRONX, NY 10467
Bronx County (718) 653-1537

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Frederick Willis's NPI number?

The NPI number for Frederick Willis is 1669194346. It was assigned to this individual provider in the NPPES registry on September 19, 2022.

Where is Frederick Willis located?

Frederick Willis practices at 3584 Jerome Ave, Bronx, NY 10467. The listed phone number is (718) 653-1537.

What is Frederick Willis's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

When was this NPI record last updated?

The NPPES record for Frederick Willis was last updated on September 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.