Provider Demographics
NPI:1043729460
Name:MCCOURT, SAMANTHA R (MS, ED)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:R
Last Name:MCCOURT
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:VEALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ED
Mailing Address - Street 1:PO BOX 1672
Mailing Address - Street 2:107C NORTH SHORE POINT
Mailing Address - City:MONTAGUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07827
Mailing Address - Country:US
Mailing Address - Phone:845-820-1731
Mailing Address - Fax:
Practice Address - Street 1:43 CONESTOGA TRAIL
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871
Practice Address - Country:US
Practice Address - Phone:914-443-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY665953766252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency