Provider Demographics
NPI:1164994257
Name:DEFILIPPO, SAMANTHA LINN (MA, CAGS, NCSP, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LINN
Last Name:DEFILIPPO
Suffix:
Gender:F
Credentials:MA, CAGS, NCSP, BCBA
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:LINN
Other - Last Name:PIETRYKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CAGS, NCSP
Mailing Address - Street 1:183 KENDALL ROAD
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:732-692-4942
Mailing Address - Fax:
Practice Address - Street 1:183 KENDALL RD
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1355
Practice Address - Country:US
Practice Address - Phone:732-692-4942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-30
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-18-30477103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst