Individual
SAMANTHA HANTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
43 MAIN ST STE 101, SPARTA, NJ 07871-1972
(201) 919-1237
Mailing address
26 GALES DR APT 2, NEW PROVIDENCE, NJ 07974-1964
(201) 919-1237
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
37FA00008100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37FA00008100
STATE LICENSE NUMBER
NJ
Enumeration date
01/28/2021
Last updated
01/28/2021
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