Provider Demographics
NPI:1437847068
Name:REDONDO, SAMANTHA MILLER (MS, AMFT)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MILLER
Last Name:REDONDO
Suffix:
Gender:F
Credentials:MS, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 W HUNTINGTON DR STE 202
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1222
Mailing Address - Country:US
Mailing Address - Phone:626-275-2644
Mailing Address - Fax:
Practice Address - Street 1:1961 W HUNTINGTON DR STE 202
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-1222
Practice Address - Country:US
Practice Address - Phone:626-275-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120870106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist