MEDICARE: SAMANTHA COTILLETTA LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	005050-1	NY

General Provider Information

NPI Number	:	1093089732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA COTILLETTA LMHC

Provider Business Mailing Address
First Line	:	14405 NEWPORT AVE
Second Line	:
City	:	NEPONSIT
State	:	NY
Zip	:	11694-1134
Country	:	US
Telephone Number	:	917-783-3988
Fax Number	:

Provider Business Practice Location Address
First Line	:	14405 NEWPORT AVE
Second Line	:
City	:	NEPONSIT
State	:	NY
Zip	:	11694-1134
Country	:	US
Telephone Number	:	917-783-3988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	02/27/2012

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