Provider Demographics
NPI:1922766468
Name:WALKER, SAMANTHA (LMSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WALKER
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 1:5583 COCKRAM RD
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:NY
Mailing Address - Zip Code:14422-9703
Mailing Address - Country:US
Mailing Address - Phone:585-356-6372
Mailing Address - Fax:
Practice Address - Street 1:80 MUNSON ST
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-8933
Practice Address - Country:US
Practice Address - Phone:585-344-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110987104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker