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Individual
MS. KIBASA SAMUEL
Active
Individual
MS. KIBASA SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CASAC, SAP MAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
31589
NY
101YP2500X
Professional Counselor
4937560
NY
104100000X
Social Worker
72091813
NY
1041C0700X
Clinical Social Worker
Primary
090232
NY
Other
Enumeration date
10/12/2015
Last updated
02/23/2022
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