Provider Demographics
NPI:1689496044
Name:SAMANTHA MARZANO LCSW PC
Entity type:Organization
Organization Name:SAMANTHA MARZANO LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-648-8198
Mailing Address - Street 1:29 CHUCK LN
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1409
Mailing Address - Country:US
Mailing Address - Phone:917-648-8198
Mailing Address - Fax:
Practice Address - Street 1:640 BELLE TERRE RD STE E
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1936
Practice Address - Country:US
Practice Address - Phone:917-648-8198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health