Provider Demographics
NPI:1366649287
Name:PERLMAN, SAMANTHA L (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:PERLMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5847 FRANCIS LEWIS BLVD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1698
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5847 FRANCIS LEWIS BLVD
Practice Address - Street 2:SUITE 15
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-1698
Practice Address - Country:US
Practice Address - Phone:347-408-4247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2016-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00070223OtherBCBSVT
VT1013835Medicaid