Provider Demographics
NPI:1003056011
Name:NUNEZ, SAMANTHA (CAS)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-3810
Mailing Address - Country:US
Mailing Address - Phone:916-394-2328
Mailing Address - Fax:916-394-2457
Practice Address - Street 1:2515 48TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-3810
Practice Address - Country:US
Practice Address - Phone:916-394-2328
Practice Address - Fax:916-394-2457
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340004BN101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor