Provider Demographics
NPI:1326744202
Name:LOGLISCI, SAMANTHA LORAINE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LORAINE
Last Name:LOGLISCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EAST AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5014
Mailing Address - Country:US
Mailing Address - Phone:203-800-6833
Mailing Address - Fax:
Practice Address - Street 1:111 EAST AVE STE 207
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5014
Practice Address - Country:US
Practice Address - Phone:203-800-6833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health