Samantha Taylor Southard | Staten Island, NY • PECOS Search

Samantha Taylor Southard

Counselor

Behavioral Health & Social Service Providers

2285 Victory Blvd Ste 1, Staten Island, NY 10314-6631

PECOS Enrollment

Based on the most recent information from CMS, provider Samantha Taylor Southard does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 1:08 PM.

Profile Details

Provider ID
1043818271
Provider Type
Individual
Full Name
Southard, Samantha Taylor
Credential
LMHC

Gender
Female
Sole Proprietor
Yes
Enumeration Date
10/10/2020
Last Updated
6/7/2024

Contact Information

Practice Location

2285 Victory Blvd Ste 1, Staten Island, NY 10314-6631

Unlisted Fax

Mailing Location

2285 Victory Blvd Ste 1, Staten Island, NY 10314-6631

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License 014490 New York