Provider Demographics
NPI:1487467791
Name:KHAN, SAMANTHA PRIYA (LP-MHC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:PRIYA
Last Name:KHAN
Suffix:
Gender:F
Credentials:LP-MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 PARSONS DR
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4712
Mailing Address - Country:US
Mailing Address - Phone:347-233-1289
Mailing Address - Fax:
Practice Address - Street 1:32 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1609
Practice Address - Country:US
Practice Address - Phone:212-298-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP127783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health