Provider Demographics
NPI:1154355139
Name:SAMIDE, JEFF LOUIS (EDD, NCC, MAC, LPC)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:LOUIS
Last Name:SAMIDE
Suffix:
Gender:M
Credentials:EDD, NCC, MAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 374C
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-9335
Mailing Address - Country:US
Mailing Address - Phone:724-423-3714
Mailing Address - Fax:724-423-2987
Practice Address - Street 1:RR 3 BOX 374C
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-9335
Practice Address - Country:US
Practice Address - Phone:724-423-3714
Practice Address - Fax:724-423-2987
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health