=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801790977
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMANTHA N KILLIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2026
-----------------------------------------------------
Last Update Date | 10/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 384 CRYSTAL RUN RD STE 102
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10941-4073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-769-8179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32B NEW ST
-----------------------------------------------------
City | EASTCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10709-3513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-820-5251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 608987612
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------