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Individual
MR. SAMUEL AUSTIN FORMANEK
Active
Individual
MR. SAMUEL AUSTIN FORMANEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
P107181
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P107181
NY STATE LICENSE PERMIT
NY
05
—
P107181
—
NY
Enumeration date
10/16/2020
Last updated
11/27/2023
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