Provider Demographics
NPI:1336703859
Name:GOLDEN, SAMANTHA ELAINE (LMHC, NCC, CCTP)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ELAINE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:LMHC, NCC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WATER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1964
Mailing Address - Country:US
Mailing Address - Phone:585-590-4463
Mailing Address - Fax:
Practice Address - Street 1:13 WATER ST STE 3
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1964
Practice Address - Country:US
Practice Address - Phone:585-590-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009562-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1346634151Medicaid