Provider Demographics
NPI:1760342950
Name:SAMUEL CLARKE, BREA O (LMSW)
Entity type:Individual
Prefix:
First Name:BREA
Middle Name:O
Last Name:SAMUEL CLARKE
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 1:42 HUNTER BROOK LN # E
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-5858
Mailing Address - Country:US
Mailing Address - Phone:929-771-4210
Mailing Address - Fax:929-771-4210
Practice Address - Street 1:326 STATE ROUTE 28N
Practice Address - Street 2:
Practice Address - City:NORTH CREEK
Practice Address - State:NY
Practice Address - Zip Code:12853-3903
Practice Address - Country:US
Practice Address - Phone:518-791-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129463104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker