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General NPI Number Information
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NPI Number | 1699816736
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Entity Type | Individual
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Provider Name | LILIRACHEL SAMSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 50 SANITORIUM RD BLDG F
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City | POMONA
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State | NY
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Zip | 10970-3555
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Country | US
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Telephone | 945-364-2275
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Fax |
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Provider Business Mailing Address
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Address Line | 16 MAIDEN LN
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City | NEW CITY
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State | NY
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Zip | 10956-6611
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Country | US
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Telephone | 845-638-1211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 58958
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License Number State | NY
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