# SAMANTHA L CHARBONNEAU PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356878128
- **Authorized official:** MRS. SAMANTHA LYNN CHARBONNEAU LMFT (MARRIAGE AND FAMILY THERAPIST)
- **Authorized official phone:** (407) 466-3467

## Contact information

- **Practice address:** 101 TIMBERLACHEN CIR STE 201, LAKE MARY, FL 32746-6124
- **Practice address phone:** (407) 466-3467
- **Practice address fax:** (407) 549-5987
- **Mailing address:** 101 TIMBERLACHEN CIR STE 201, LAKE MARY, FL 32746-6124
- **Mailing address phone:** (407) 466-3467
- **Mailing address fax:** (407) 549-5987

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | MT2058 | FL | Yes |

## Other

- **Enumeration date:** 05/11/2017
- **Last updated:** 05/11/2017