Provider Demographics
NPI:1669843504
Name:SAMLAL, KEVONN (LMSW)
Entity type:Individual
Prefix:MR
First Name:KEVONN
Middle Name:
Last Name:SAMLAL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W 50TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10020-1201
Mailing Address - Country:US
Mailing Address - Phone:917-912-4082
Mailing Address - Fax:
Practice Address - Street 1:135 W 50TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020-1201
Practice Address - Country:US
Practice Address - Phone:917-912-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094587104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker