Provider Demographics
NPI:1124404777
Name:CIANCI, SAMANTHA JO (BA, MA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:CIANCI
Suffix:
Gender:F
Credentials:BA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 THIRD BEACH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5739
Mailing Address - Country:US
Mailing Address - Phone:908-415-5201
Mailing Address - Fax:
Practice Address - Street 1:440 THIRD BEACH RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5739
Practice Address - Country:US
Practice Address - Phone:908-415-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health