Provider Demographics
NPI:1053045641
Name:CHILDS, SAMANTHA LYNNE
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LYNNE
Last Name:CHILDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:LYNNE
Other - Last Name:LOCASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 N WASHINGTON ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-2907
Mailing Address - Country:US
Mailing Address - Phone:315-867-1440
Mailing Address - Fax:315-867-1431
Practice Address - Street 1:301 N WASHINGTON ST STE 2300
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-2907
Practice Address - Country:US
Practice Address - Phone:315-867-1440
Practice Address - Fax:315-867-1431
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator