Provider Demographics
NPI:1679085922
Name:PRESTANO, SAMANTHA BRETT (MHC-LP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BRETT
Last Name:PRESTANO
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 37TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3932
Mailing Address - Country:US
Mailing Address - Phone:718-721-4300
Mailing Address - Fax:
Practice Address - Street 1:3109 37TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3932
Practice Address - Country:US
Practice Address - Phone:718-721-4300
Practice Address - Fax:718-721-5600
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP03742101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health