Healthcare Provider Details

I. General information

NPI: 1932009701
Provider Name (Legal Business Name): SHELIZA ROZANNA SAMUELS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2026
Last Update Date: 11/06/2026
Certification Date: 11/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 LAKEVIEW AVE
SCHENECTADY NY
12303-1840
US

IV. Provider business mailing address

1061 LAKEVIEW AVE
SCHENECTADY NY
12303-1840
US

V. Phone/Fax

Practice location:
  • Phone: 646-330-0989
  • Fax:
Mailing address:
  • Phone: 646-330-0989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number016008
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: