Provider Demographics
NPI:1306356951
Name:CALLISTER, SAMANTHA JEAN (LMSW CASAC-M)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JEAN
Last Name:CALLISTER
Suffix:
Gender:F
Credentials:LMSW CASAC-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3109
Mailing Address - Country:US
Mailing Address - Phone:516-200-1669
Mailing Address - Fax:631-302-6641
Practice Address - Street 1:2250 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3109
Practice Address - Country:US
Practice Address - Phone:631-200-1669
Practice Address - Fax:631-302-6641
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33173101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty