Provider Demographics
NPI:1972163798
Name:MORELLO, SAMANTHA M (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:MORELLO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:STAATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12580-6028
Mailing Address - Country:US
Mailing Address - Phone:845-889-4034
Mailing Address - Fax:
Practice Address - Street 1:815 BLOOMING GROVE TPKE STE 601
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-8138
Practice Address - Country:US
Practice Address - Phone:845-527-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029614235Z00000X
NY0979547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty