MEDICARE: SAMANTHA FANTAUZZI

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	106H00000X	Marriage & Family Therapist	002618	NY

General Provider Information

NPI Number	:	1508735465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA FANTAUZZI

Provider Business Mailing Address
First Line	:	1613 ROUTE 9D
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-7104
Country	:	US
Telephone Number	:	845-844-0708
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 STONY BROOK CT
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12550-6556
Country	:	US
Telephone Number	:	845-844-0708
Fax Number	:

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

Provider Enumeration Date	:	10/30/2025
Last Update Date	:	01/14/2026

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Directions to “ SAMANTHA FANTAUZZI ” Practice Location

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