Provider Demographics
NPI:1578841409
Name:MCDANIEL, SAMANTHA RECINTO (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RECINTO
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JOSE
Other - Last Name:RECINTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:640 N RIVER RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8949
Mailing Address - Country:US
Mailing Address - Phone:630-718-0747
Mailing Address - Fax:
Practice Address - Street 1:640 N RIVER RD
Practice Address - Street 2:SUITE 108
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-718-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33005917A104100000X
IN34006682A1041C0700X
IL1490160051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker