Provider Demographics
NPI:1316390503
Name:WILLIAMS, SAMANTHA (RBT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12225 SW 151ST ST APT 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5977
Mailing Address - Country:US
Mailing Address - Phone:305-484-8314
Mailing Address - Fax:
Practice Address - Street 1:12225 SW 151ST ST APT 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186
Practice Address - Country:US
Practice Address - Phone:305-484-8314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-16-24036106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022317000Medicaid
RBT-16-24036OtherBEHAVIOR ANALYST CERTIFICATION BOARD