Provider Demographics
NPI:1508545872
Name:AGIN, SAMANTHA (LMSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:AGIN
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 1:340 E 80TH ST APT 17G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0930
Mailing Address - Country:US
Mailing Address - Phone:847-770-3706
Mailing Address - Fax:
Practice Address - Street 1:9520 63RD RD STE K
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1145
Practice Address - Country:US
Practice Address - Phone:888-224-7312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical