Provider Demographics
NPI:1992308555
Name:SAMPATH, SAMANTHA ALANA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ALANA
Last Name:SAMPATH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:ALANA
Other - Last Name:SAMPATH-REYNOLDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:799 S 3RD ST APT 2534
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-2190
Mailing Address - Country:US
Mailing Address - Phone:917-287-1421
Mailing Address - Fax:
Practice Address - Street 1:799 S 3RD ST APT 2534
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-2190
Practice Address - Country:US
Practice Address - Phone:917-287-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health