Provider Demographics
NPI:1346789369
Name:WITHROW, SAMANTHA (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WITHROW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 S GOVERNORS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-6920
Mailing Address - Country:US
Mailing Address - Phone:302-382-8698
Mailing Address - Fax:
Practice Address - Street 1:1058 S GOVERNORS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6920
Practice Address - Country:US
Practice Address - Phone:302-382-8698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00015071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical