Provider Demographics
NPI:1447405238
Name:PETERKIN, SAMANTHA PATRICIA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:PATRICIA
Last Name:PETERKIN
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 1:176 GIBSON AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-2049
Mailing Address - Country:US
Mailing Address - Phone:917-202-1694
Mailing Address - Fax:914-423-6128
Practice Address - Street 1:176 GIBSON AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-2049
Practice Address - Country:US
Practice Address - Phone:914-964-5496
Practice Address - Fax:914-423-6128
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0704407-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool