Healthcare Provider Details

I. General information

NPI: 1972253714
Provider Name (Legal Business Name): SAMANTHA KATE CIPRIANO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 76TH ST
NEW YORK NY
10021-3396
US

IV. Provider business mailing address

126 HIGHVIEW ST
MAMARONECK NY
10543-1111
US

V. Phone/Fax

Practice location:
  • Phone: 914-671-4998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPENDING
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: