Provider Demographics
NPI:1255640223
Name:GAWAD, SAMANTHA (LMSW)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:GAWAD
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 1:89 S HIGHLAND AVE APT B35
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-5632
Mailing Address - Country:US
Mailing Address - Phone:914-631-2400
Mailing Address - Fax:
Practice Address - Street 1:3060 E TREMONT AVE
Practice Address - Street 2:C/O YAI
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5726
Practice Address - Country:US
Practice Address - Phone:914-631-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097322-1104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical