MEDICARE: SAMANTHA DINGA MA

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		MA
2	251S00000X	Community/Behavioral Health Agency		MA
3	101YM0800X	Mental Health Counselor	014391	NY

General Provider Information

NPI Number	:	1255914891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA DINGA MA

Provider Business Mailing Address
First Line	:	2535 BRIGHTON HENRIETTA TOWN LINE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-2711
Country	:	US
Telephone Number	:	585-201-8626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2535 BRIGHTON HENRIETTA TOWN LINE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-2711
Country	:	US
Telephone Number	:	585-201-8626
Fax Number	:

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

Provider Enumeration Date	:	05/02/2021
Last Update Date	:	02/13/2024

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Directions to “ SAMANTHA DINGA MA” Practice Location

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