Provider Demographics
NPI:1326772971
Name:MARIN, SAMANTHA WYATT (LMSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:WYATT
Last Name:MARIN
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 1:190 E 7TH ST APT 612
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-5979
Mailing Address - Country:US
Mailing Address - Phone:973-951-2000
Mailing Address - Fax:
Practice Address - Street 1:190 E 7TH ST APT 612
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-5979
Practice Address - Country:US
Practice Address - Phone:973-951-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116440-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY116440-01OtherISSUER