Provider Demographics
NPI:1568177350
Name:SAMS, EDNA JOYCE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:EDNA
Middle Name:JOYCE
Last Name:SAMS
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 1:75 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-1157
Mailing Address - Country:US
Mailing Address - Phone:646-261-1193
Mailing Address - Fax:
Practice Address - Street 1:2330 BRONX PARK E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-7578
Practice Address - Country:US
Practice Address - Phone:212-889-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094475104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3957Medicaid