Provider Demographics
NPI:1346687480
Name:KORMANIK, SAMANTHA DAWN (MA,, LPC)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:DAWN
Last Name:KORMANIK
Suffix:
Gender:F
Credentials:MA,, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 DUNCAN AVE APT 715
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5034
Mailing Address - Country:US
Mailing Address - Phone:412-418-2003
Mailing Address - Fax:
Practice Address - Street 1:711 DUNCAN AVE APT 715
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5034
Practice Address - Country:US
Practice Address - Phone:412-418-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional