Provider Demographics
NPI:1952156838
Name:BALLARD, SAMANTHA KATE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KATE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 CLAREMONT GDNS
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-3340
Mailing Address - Country:US
Mailing Address - Phone:714-609-0453
Mailing Address - Fax:
Practice Address - Street 1:182 CLAREMONT GDNS
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-3340
Practice Address - Country:US
Practice Address - Phone:714-609-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist