Provider Demographics
NPI:1497764203
Name:SAMARO, EDWARD JOHN (LMHC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JOHN
Last Name:SAMARO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:331 WEST CENTRAL AVE
Mailing Address - Street 2:211
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880
Mailing Address - Country:US
Mailing Address - Phone:863-216-5927
Mailing Address - Fax:877-560-4258
Practice Address - Street 1:52 SAINT KITTS CIR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3500
Practice Address - Country:US
Practice Address - Phone:863-216-5927
Practice Address - Fax:877-560-4258
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767396500Medicaid