Healthcare Provider Details

I. General information

NPI: 1750923074
Provider Name (Legal Business Name): TAYLOR SAMANIUK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21155 WHITFIELD PL STE 202
STERLING VA
20165-7277
US

IV. Provider business mailing address

21155 WHITFIELD PL STE 202
STERLING VA
20165-7277
US

V. Phone/Fax

Practice location:
  • Phone: 571-375-0668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012494
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: