Provider Demographics
NPI:1689473605
Name:SAMPSON, EULEX ZALICA
Entity type:Individual
Prefix:
First Name:EULEX
Middle Name:ZALICA
Last Name:SAMPSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-2815
Mailing Address - Country:US
Mailing Address - Phone:347-988-4562
Mailing Address - Fax:
Practice Address - Street 1:969 E 104TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-2815
Practice Address - Country:US
Practice Address - Phone:347-988-4562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker