Provider Demographics
NPI:1629759220
Name:FRISONE, SAMANTHA SAMATARO (MFTA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SAMATARO
Last Name:FRISONE
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 PICKETT LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8768
Mailing Address - Country:US
Mailing Address - Phone:770-354-9102
Mailing Address - Fax:
Practice Address - Street 1:1056 WELLINGTON WAY STE 160
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-2002
Practice Address - Country:US
Practice Address - Phone:859-201-1705
Practice Address - Fax:859-207-5481
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY281977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health