Provider Demographics
NPI:1235855248
Name:WOOD, SAMANTHA (ACSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:750 MACARTHUR BLVD APT 304
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3702
Mailing Address - Country:US
Mailing Address - Phone:209-684-4458
Mailing Address - Fax:
Practice Address - Street 1:1292 PAGE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3064
Practice Address - Country:US
Practice Address - Phone:415-621-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110667101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical