Provider Demographics
NPI:1487837340
Name:LEDERMAN, SAMANTHA JORDAN (MA)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:JORDAN
Last Name:LEDERMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35986 W 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2510
Mailing Address - Country:US
Mailing Address - Phone:248-867-0260
Mailing Address - Fax:
Practice Address - Street 1:38345 W 10 MILE RD
Practice Address - Street 2:FREEWAY OFFICE PLAZA, SUITE 150
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2867
Practice Address - Country:US
Practice Address - Phone:248-478-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361001999103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist