Healthcare Provider Details

I. General information

NPI: 1902719610
Provider Name (Legal Business Name): SAMANTHA MARIE FROHM BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 STATE HIGHWAY 37B
MASSENA NY
13662-3131
US

IV. Provider business mailing address

260 STATE HIGHWAY 37B
MASSENA NY
13662-3131
US

V. Phone/Fax

Practice location:
  • Phone: 315-854-4847
  • Fax:
Mailing address:
  • Phone: 315-854-4847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA2899
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: