Provider Demographics
NPI:1164824637
Name:MCCORMICK, SAMANTHA (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-1101
Mailing Address - Country:US
Mailing Address - Phone:631-379-7236
Mailing Address - Fax:
Practice Address - Street 1:55 38TH ST
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-1101
Practice Address - Country:US
Practice Address - Phone:631-379-7236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist