Provider Demographics
NPI:1093361651
Name:SAMOS, MARKOS WILLIAM (LPC)
Entity Type:Individual
Prefix:
First Name:MARKOS
Middle Name:WILLIAM
Last Name:SAMOS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROBINHOOD DR
Mailing Address - Street 2:
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335-1321
Mailing Address - Country:US
Mailing Address - Phone:860-287-7554
Mailing Address - Fax:
Practice Address - Street 1:33 ROBINHOOD DR
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1321
Practice Address - Country:US
Practice Address - Phone:860-287-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health