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General NPI Number Information
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NPI Number | 1205462231
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Entity Type | Individual
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Provider Name | SAMANTHA DALE LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/21/2020
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 21 NANCY DR
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City | SAYVILLE
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State | NY
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Zip | 11782-2914
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Country | US
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Telephone | 631-942-7447
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Fax |
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Provider Business Mailing Address
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Address Line | 147 ROSEBUD CT
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City | PATCHOGUE
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State | NY
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Zip | 11772-4180
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Country | US
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Telephone |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 090337
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License Number State | NY
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