Provider Demographics
NPI:1235735671
Name:WARNER, SAMANTHA (ASW)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:PESCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:94060-0055
Mailing Address - Country:US
Mailing Address - Phone:562-852-4334
Mailing Address - Fax:
Practice Address - Street 1:2599 CLOVERDALE ROAD
Practice Address - Street 2:
Practice Address - City:PESCADERO
Practice Address - State:CA
Practice Address - Zip Code:94060-0055
Practice Address - Country:US
Practice Address - Phone:562-852-4334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98912104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker