Healthcare Provider Details

I. General information

NPI: 1710402680
Provider Name (Legal Business Name): SAMANTHA PARKER-ZILLICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA PARKER-ZILLICH

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4619 GREENE ST NW STE C
ALBUQUERQUE NM
87114-4899
US

IV. Provider business mailing address

4619 GREENE ST NW STE C
ALBUQUERQUE NM
87114-4899
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-2232
  • Fax:
Mailing address:
  • Phone: 505-226-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberC-11891
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11891
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: