Provider Demographics
NPI:1992181804
Name:NORELLI, SAMANTHA KATE (LMHC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KATE
Last Name:NORELLI
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 1:339 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204-2708
Mailing Address - Country:US
Mailing Address - Phone:518-465-5204
Mailing Address - Fax:
Practice Address - Street 1:339 BROADWAY
Practice Address - Street 2:
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204-2708
Practice Address - Country:US
Practice Address - Phone:518-465-5204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005766101YM0800X
NC11615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health