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General NPI Number Information
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NPI Number | 1821709742
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Entity Type | Individual
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Provider Name | SAMANTHA DALY MARTIN MA, LPC, NCC, CADC
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Gender | Female
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 49 S MAIN ST STE 103
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City | PITTSTON
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State | PA
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Zip | 18640-1702
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Country | US
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Telephone | 570-592-5818
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Fax |
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Provider Business Mailing Address
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Address Line | 201 ALICIA ST
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City | OLD FORGE
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State | PA
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Zip | 18518-1903
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Country | US
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Telephone | 570-592-5818
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC018417
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License Number State | PA
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