Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 32700 | NY |
NPI | 1003388661 |
---|---|
Provider Name | Samantha Bassett |
First Address | Hempstead, NY 11550-3702 |
Second Address | Hempstead, NY 11550-3702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2018 |
Last Update Date | 20/12/2018 |