Provider Demographics
NPI:1255931697
Name:MARISTANY, SAMANTHA (LCSW LADC CCS LICSW)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:MARISTANY
Suffix:
Gender:F
Credentials:LCSW LADC CCS LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5424
Mailing Address - Country:US
Mailing Address - Phone:207-331-4371
Mailing Address - Fax:
Practice Address - Street 1:725 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5424
Practice Address - Country:US
Practice Address - Phone:207-331-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC211391041C0700X
MECCS8543101YA0400X
MELC8009101YA0400X
MALICSW1262571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)