=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407776404
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPSTATE CENTER FOR OCD & ANXIETY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2026
-----------------------------------------------------
Last Update Date | 07/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 451 GLEN ST
-----------------------------------------------------
City | GLENS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12801-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-480-7223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 451 GLEN ST
-----------------------------------------------------
City | GLENS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12801-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-480-7223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | CARLY SAMACH
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 518-788-8044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------