Provider Demographics
NPI:1376718353
Name:SANGANA, SAMANTHA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:SANGANA
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 1:2555 E COLORADO BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-6622
Mailing Address - Country:US
Mailing Address - Phone:626-577-2261
Mailing Address - Fax:626-577-2543
Practice Address - Street 1:2555 E COLORADO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-6622
Practice Address - Country:US
Practice Address - Phone:626-577-2261
Practice Address - Fax:626-577-2543
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 220561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical