Provider Demographics
NPI:1588134860
Name:WALDMAN, SAMANTHA (LMHC, MA, EDM)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:LMHC, MA, EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 PARK PL APT 1R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4073
Mailing Address - Country:US
Mailing Address - Phone:908-601-7258
Mailing Address - Fax:
Practice Address - Street 1:875 6TH AVE RM 1602
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3574
Practice Address - Country:US
Practice Address - Phone:908-601-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP13335101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health