Provider Demographics
NPI:1023502721
Name:SAMARAS, EVANGELOS ANASTASIOS (LMHC)
Entity type:Individual
Prefix:
First Name:EVANGELOS
Middle Name:ANASTASIOS
Last Name:SAMARAS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 31ST ST REAR HOUSE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2786
Mailing Address - Country:US
Mailing Address - Phone:718-427-0361
Mailing Address - Fax:
Practice Address - Street 1:2246 31ST ST REAR HOUSE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2786
Practice Address - Country:US
Practice Address - Phone:718-427-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008803101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008803OtherLICENSE FROM OFFICE OF PROFESSIONS/BOARD OF ED