Provider Demographics
NPI:1609437953
Name:QUINTERO, SAMARA (LMFT)
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 SE 16TH CT APT 3
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2513
Mailing Address - Country:US
Mailing Address - Phone:954-817-9259
Mailing Address - Fax:
Practice Address - Street 1:2601 E OAKLAND PARK BLVD STE 502
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33306-1617
Practice Address - Country:US
Practice Address - Phone:954-488-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3265106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist