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General NPI Number Information
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NPI Number | 1215713219
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Entity Type | Individual
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Provider Name | PEACH SIMONE SAMPSON-LIVERPOOL MS
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Gender | Female
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Dates
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Enumeration Date | 09/05/2023
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 119 SCHENECTADY AVE FL 3
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City | BROOKLYN
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State | NY
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Zip | 11213-2330
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Country | US
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Telephone | 347-915-1112
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Fax | 347-915-1113
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Provider Business Mailing Address
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Address Line | 2237 RENFREW AVE
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City | ELMONT
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State | NY
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Zip | 11003-2820
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Country | US
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Telephone | 516-225-5088
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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 | NY
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