Healthcare Provider Details

I. General information

NPI: 1831440247
Provider Name (Legal Business Name): JEFFREY SAMANEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 E MAIN ST
MOUNT KISCO NY
10549-3027
US

IV. Provider business mailing address

580 WHITE PLAINS RD STE 580
TARRYTOWN NY
10591-5198
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-4646
  • Fax:
Mailing address:
  • Phone: 914-345-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number086286
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number001149
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number086188
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: