Provider Demographics
NPI:1417041161
Name:LITTLEFIELD, SAMANTHA J (LISW)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:J
Last Name:LITTLEFIELD
Suffix:
Gender:F
Credentials:LISW
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 8701
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88006-8701
Mailing Address - Country:US
Mailing Address - Phone:575-621-2687
Mailing Address - Fax:
Practice Address - Street 1:715 E IDAHO AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-4703
Practice Address - Country:US
Practice Address - Phone:575-642-8046
Practice Address - Fax:575-526-9819
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-052291041C0700X
NMI-068171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03146112003Medicaid