MEDICARE: SAMANTHA SCULNICK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1255760450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA SCULNICK LCSW

Provider Business Mailing Address
First Line	:	125 E 23RD ST STE 500
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-4581
Country	:	US
Telephone Number	:	917-983-0106
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 E 23RD ST STE 500
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-4581
Country	:	US
Telephone Number	:	212-989-2990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	02/11/2019

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