Provider Demographics
NPI:1275172199
Name:ROSS, SAMANTHA BRETON (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:BRETON
Last Name:ROSS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WINANS PL APT B
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1261
Mailing Address - Country:US
Mailing Address - Phone:914-382-0044
Mailing Address - Fax:
Practice Address - Street 1:311 WINANS PL APT B
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1261
Practice Address - Country:US
Practice Address - Phone:914-382-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000485-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist