Healthcare Provider Details

I. General information

NPI: 1801790977
Provider Name (Legal Business Name): SAMANTHA N KILLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 CRYSTAL RUN RD STE 102
MIDDLETOWN NY
10941-4073
US

IV. Provider business mailing address

32B NEW ST
EASTCHESTER NY
10709-3513
US

V. Phone/Fax

Practice location:
  • Phone: 845-769-8179
  • Fax:
Mailing address:
  • Phone: 845-820-5251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number608987612
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: