Provider Demographics
NPI:1306329123
Name:HOUSE, SAMANTHA MARIE (PMHNP, RNFA)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:MARIE
Last Name:HOUSE
Suffix:
Gender:F
Credentials:PMHNP, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:620 ERIE BLVD W STE 302
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2463
Mailing Address - Country:US
Mailing Address - Phone:315-472-7363
Mailing Address - Fax:315-472-0084
Practice Address - Street 1:620 ERIE BLVD W
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2445
Practice Address - Country:US
Practice Address - Phone:315-472-7363
Practice Address - Fax:315-472-0084
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY532811163WR0006X
NYF405062-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant