Provider Demographics
NPI:1477699353
Name:KLEINMAN, SAMANTHA NATHANIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:NATHANIA
Last Name:KLEINMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 PROPP AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-2312
Mailing Address - Country:US
Mailing Address - Phone:516-305-4726
Mailing Address - Fax:
Practice Address - Street 1:16110 JAMAICA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6139
Practice Address - Country:US
Practice Address - Phone:718-704-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056368-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244624Medicaid