MEDICARE: SAMANTHA PARKER-ZILLICH 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	171M00000X	Case Manager/Care Coordinator		NM
2	171M00000X	Case Manager/Care Coordinator	C-11891	NM
3	1041C0700X	Clinical Social Worker	C-11891	NM

General Provider Information

NPI Number	:	1710402680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA PARKER-ZILLICH LCSW

Provider Business Mailing Address
First Line	:	4619 GREENE ST NW STE C
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4899
Country	:	US
Telephone Number	:	505-226-2232
Fax Number	:

Provider Business Practice Location Address
First Line	:	4619 GREENE ST NW STE C
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4899
Country	:	US
Telephone Number	:	505-226-2232
Fax Number	:

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

Provider Enumeration Date	:	08/11/2017
Last Update Date	:	03/11/2026

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