Provider Demographics
NPI:1699188219
Name:SAMANTHA COLE LCSW
Entity Type:Organization
Organization Name:SAMANTHA COLE LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:607-354-4602
Mailing Address - Street 1:1004 STATE HIGHWAY 7 BLDG B
Mailing Address - Street 2:
Mailing Address - City:UNADILLA
Mailing Address - State:NY
Mailing Address - Zip Code:13849-3137
Mailing Address - Country:US
Mailing Address - Phone:607-354-4602
Mailing Address - Fax:607-215-4201
Practice Address - Street 1:1004 STATE HIGHWAY 7 BLDG B
Practice Address - Street 2:
Practice Address - City:UNADILLA
Practice Address - State:NY
Practice Address - Zip Code:13849-3137
Practice Address - Country:US
Practice Address - Phone:607-354-4602
Practice Address - Fax:607-215-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081663251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health