Healthcare Provider Details

I. General information

NPI: 1982433223
Provider Name (Legal Business Name): SAMANTHA MAGUIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N PROSPECT ST
HERKIMER NY
13350-1912
US

IV. Provider business mailing address

678 SNELLS BUSH RD
LITTLE FALLS NY
13365-3013
US

V. Phone/Fax

Practice location:
  • Phone: 315-866-0100
  • Fax:
Mailing address:
  • Phone: 315-939-2965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number028491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: