Individual
KAITLYN SAMPLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRPA
Contact information
Practice address
19 BEECH ST, LAKE GROVE, NY 11755-3141
(631) 672-1463
Mailing address
19 BEECH ST, LAKE GROVE, NY 11755-3141
Taxonomy
Speciality
Code
Description
License number
State
261QR0800X
Recovery Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/25/2025
Last updated
09/25/2025
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