Healthcare Provider Details

I. General information

NPI: 1063348118
Provider Name (Legal Business Name): SAMANTHA VALIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WHITESBORO ST
UTICA NY
13502-3015
US

IV. Provider business mailing address

518 JAMES ST
SYRACUSE NY
13203-2238
US

V. Phone/Fax

Practice location:
  • Phone: 315-724-5168
  • Fax:
Mailing address:
  • Phone: 315-474-5506
  • Fax: 315-474-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: