Healthcare Provider Details

I. General information

NPI: 1497527634
Provider Name (Legal Business Name): SAMANTHA MARIE GOFFREDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 LINWOOD ST # 1949
NEW BRITAIN CT
06052-1949
US

IV. Provider business mailing address

370 LINWOOD ST # 1949
NEW BRITAIN CT
06052-1949
US

V. Phone/Fax

Practice location:
  • Phone: 203-577-7748
  • Fax:
Mailing address:
  • Phone: 203-577-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: