Provider Demographics
NPI:1497321574
Name:MORRIS, SAMANTHA D
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:D
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 GAP NEWPORT PIKE
Mailing Address - Street 2:
Mailing Address - City:ATGLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19310-1760
Mailing Address - Country:US
Mailing Address - Phone:484-431-0813
Mailing Address - Fax:
Practice Address - Street 1:1215 W BALTIMORE PIKE STE 1
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5540
Practice Address - Country:US
Practice Address - Phone:484-431-0813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138145104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker