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General NPI Number Information
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NPI Number | 1740435023
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Entity Type | Individual
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Provider Name | CECILIA Y.N. SAM LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/30/2008
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Last Update Date | 11/30/2008
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Provider Practice Location Address
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Address Line | 75 ELDRIDGE ST #4
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City | NEW YORK
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State | NY
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Zip | 10002-5241
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Country | US
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Telephone | 917-623-1139
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Fax |
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Provider Business Mailing Address
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Address Line | 8521 MIDLAND PKWY
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City | JAMAICA
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State | NY
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Zip | 11432-2220
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Country | US
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Telephone | 718-291-8051
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Fax | 718-291-8051
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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 | 074698
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License Number State | NY
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