Healthcare Provider Details

I. General information

NPI: 1154246023
Provider Name (Legal Business Name): SAM M ARDITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W 26TH ST
NEW YORK NY
10001-6804
US

IV. Provider business mailing address

4622 BEDFORD AVE
BROOKLYN NY
11235-2612
US

V. Phone/Fax

Practice location:
  • Phone: 917-994-0462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: