Provider Demographics
NPI:1346620762
Name:DURKIN, SAMANTHA L (MED)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:DURKIN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 COMMONWEALTH AVE
Mailing Address - Street 2:APT. 6
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-4817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1120 COMMONWEALTH AVE
Practice Address - Street 2:APT. 6
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-4817
Practice Address - Country:US
Practice Address - Phone:215-704-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health