Provider Demographics
NPI:1619287547
Name:SAMWAYS, THERESA WIEHAGEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:WIEHAGEN
Last Name:SAMWAYS
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 1:104 SWAN ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1131
Mailing Address - Country:US
Mailing Address - Phone:315-212-4634
Mailing Address - Fax:
Practice Address - Street 1:104 SWAN ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1131
Practice Address - Country:US
Practice Address - Phone:315-212-4634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100035691041C0700X
NY079457-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical