Provider Demographics
NPI:1912176132
Name:SAMPSON WOODARD, RENEE E (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:E
Last Name:SAMPSON WOODARD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MILLS RD
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-2807
Mailing Address - Country:US
Mailing Address - Phone:845-313-0317
Mailing Address - Fax:914-948-9564
Practice Address - Street 1:14 MILLS RD
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-2807
Practice Address - Country:US
Practice Address - Phone:845-313-0317
Practice Address - Fax:914-948-9564
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07036661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical