Provider Demographics
NPI:1497767305
Name:SAMEK, SUSAN (LCAT, LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:SAMEK
Suffix:
Gender:F
Credentials:LCAT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:NARROWSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12764-5905
Mailing Address - Country:US
Mailing Address - Phone:845-252-5022
Mailing Address - Fax:
Practice Address - Street 1:922 CHURCH ST STE 3
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1921
Practice Address - Country:US
Practice Address - Phone:516-528-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012870101YP2500X
NY000066221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist