Healthcare Provider Details

I. General information

NPI: 1407776404
Provider Name (Legal Business Name): UPSTATE CENTER FOR OCD & ANXIETY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 GLEN ST
GLENS FALLS NY
12801-2905
US

IV. Provider business mailing address

451 GLEN ST
GLENS FALLS NY
12801-2905
US

V. Phone/Fax

Practice location:
  • Phone: 518-480-7223
  • Fax:
Mailing address:
  • Phone: 518-480-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CARLY SAMACH
Title or Position: CLINICAL DIRECTOR
Credential: LMHC
Phone: 518-788-8044