Provider Demographics
NPI:1235604158
Name:STEFANIAK, SAMANTHA JADE (MHC-P)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JADE
Last Name:STEFANIAK
Suffix:
Gender:F
Credentials:MHC-P
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JADE
Other - Last Name:PANGRAZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHC-P
Mailing Address - Street 1:1000 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1102
Mailing Address - Country:US
Mailing Address - Phone:716-842-0440
Mailing Address - Fax:
Practice Address - Street 1:1000 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1102
Practice Address - Country:US
Practice Address - Phone:716-842-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-07
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor