Provider Demographics
NPI:1053867937
Name:FAVARA, SAMANTHA (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:
Last Name:FAVARA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 DOLSON AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6489
Mailing Address - Country:US
Mailing Address - Phone:845-342-5789
Mailing Address - Fax:845-344-0510
Practice Address - Street 1:41 DOLSON AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6489
Practice Address - Country:US
Practice Address - Phone:845-342-5789
Practice Address - Fax:845-344-0510
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007423101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health