Provider Demographics
NPI:1104115062
Name:DAREFF, SAMANTHA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DAREFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 3RD ST
Mailing Address - Street 2:3R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4852
Mailing Address - Country:US
Mailing Address - Phone:917-714-4541
Mailing Address - Fax:
Practice Address - Street 1:38 3RD ST
Practice Address - Street 2:3R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4852
Practice Address - Country:US
Practice Address - Phone:917-714-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X
NY082077-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health