Provider Demographics
NPI:1962921858
Name:OZEGOVICH, SAMANTHA (LMSW)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:OZEGOVICH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 E CARVER ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3409
Mailing Address - Country:US
Mailing Address - Phone:631-673-5433
Mailing Address - Fax:
Practice Address - Street 1:17 E CARVER ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3409
Practice Address - Country:US
Practice Address - Phone:631-673-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1036431041C0700X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical