Provider Demographics
NPI:1316345176
Name:CASTRO, SAMANTHA M (LMHC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:CASTRO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-17 101 AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416
Mailing Address - Country:US
Mailing Address - Phone:516-458-4503
Mailing Address - Fax:
Practice Address - Street 1:9217 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2316
Practice Address - Country:US
Practice Address - Phone:516-458-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006293251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health