Provider Information for 1497764203
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Mr. EDWARD JOHN SAMARO LMHC
Sex: Male
NPI: 1497764203
Last Updated: 2015-04-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1497764203 | ||||||||
| Enumeration Date | 2006-08-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 331 WEST CENTRAL AVE 211 WINTER HAVEN, FL 33880 United States Phone: 863-216-5927 | Fax:877-560-4258 | ||||||||
| Primary Practice Address | 52 SAINT KITTS CIR WINTER HAVEN, FL 33884-3500 United States Phone: 863-216-5927 | Fax:877-560-4258 | ||||||||
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