Provider Demographics
NPI:1013320621
Name:COLE, SAMANTHA (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:COLE
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 1:1004 STATE HIGHWAY 7 BLDG B
Mailing Address - Street 2:
Mailing Address - City:UNADILLA
Mailing Address - State:NY
Mailing Address - Zip Code:13849-3137
Mailing Address - Country:US
Mailing Address - Phone:607-354-4602
Mailing Address - Fax:607-215-4201
Practice Address - Street 1:1004 STATE HIGHWAY 7 BLDG B
Practice Address - Street 2:
Practice Address - City:UNADILLA
Practice Address - State:NY
Practice Address - Zip Code:13849-3137
Practice Address - Country:US
Practice Address - Phone:607-354-4602
Practice Address - Fax:607-215-4201
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0816631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical