Provider Demographics
NPI:1578975272
Name:MANOS, SAMANTHA (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:MANOS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 STONEY POINT WAY
Mailing Address - Street 2:
Mailing Address - City:STONEY BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:21226-2141
Mailing Address - Country:US
Mailing Address - Phone:434-417-0142
Mailing Address - Fax:
Practice Address - Street 1:770 RITCHIE HWY STE W16
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4158
Practice Address - Country:US
Practice Address - Phone:410-294-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker