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General NPI Number Information
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NPI Number | 1043861032
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Entity Type | Individual
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Provider Name | SAMANTHA GAGE OTTO LPC, NCC, CAADC
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Gender | Female
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Dates
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Enumeration Date | 09/22/2019
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 806 VETERANS HWY
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City | BRISTOL
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State | PA
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Zip | 19007-2507
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Country | US
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Telephone | 267-689-7875
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Fax |
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Provider Business Mailing Address
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Address Line | 102 W PROSPECT AVE
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City | LANGHORNE
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State | PA
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Zip | 19047-3912
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Country | US
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Telephone | 609-477-2652
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | PC011740
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License Number State | PA
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