Provider Demographics
NPI:1003682725
Name:SAMADI NAMIN, AZIN (LMSW)
Entity Type:Individual
Prefix:
First Name:AZIN
Middle Name:
Last Name:SAMADI NAMIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SPRING MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-2439
Mailing Address - Country:US
Mailing Address - Phone:917-232-4718
Mailing Address - Fax:
Practice Address - Street 1:39 SPRING MEADOW CT
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-2439
Practice Address - Country:US
Practice Address - Phone:917-232-4718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122047104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker