Provider Demographics
NPI:1891913067
Name:GORMAN, SAMANTHA C (MS, NCC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:C
Last Name:GORMAN
Suffix:
Gender:F
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3802
Mailing Address - Country:US
Mailing Address - Phone:516-822-3131
Mailing Address - Fax:516-822-3184
Practice Address - Street 1:12 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3802
Practice Address - Country:US
Practice Address - Phone:516-822-3131
Practice Address - Fax:516-822-3184
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health