Provider Demographics
NPI:1588262364
Name:WILLOW, SONAM BEN (LMSW)
Entity type:Individual
Prefix:MS
First Name:SONAM
Middle Name:BEN
Last Name:WILLOW
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 1:1626 WOOLSEY ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-1312
Mailing Address - Country:US
Mailing Address - Phone:518-527-4244
Mailing Address - Fax:
Practice Address - Street 1:10 COLVIN AVE STE 102
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1242
Practice Address - Country:US
Practice Address - Phone:518-438-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0705501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical