Provider Demographics
NPI:1598176018
Name:BIRTWELL, SAMANTHA (MA,BA,LMFT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BIRTWELL
Suffix:
Gender:F
Credentials:MA,BA,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2035
Mailing Address - Country:US
Mailing Address - Phone:203-300-6414
Mailing Address - Fax:203-702-5283
Practice Address - Street 1:731 MAIN ST STE 122
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2872
Practice Address - Country:US
Practice Address - Phone:203-261-7090
Practice Address - Fax:203-702-5283
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1736106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT13584798OtherCAQH
CTD339123 141 E MAINOtherVALUE OPTIONS
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherUBH-UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CTACTIVE MEMBEROtherAAMFT
CTPENDINGOtherMHN TRICARE NORTH
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CT008062567Medicaid
CT060669017OtherUBH-OXFORD HEALTH/FREEDOM/LIBERTY WELLMORE GRP/FACILITY
CTPENDINGOtherMHN-MANAGED HEALTH NETWORK
CTPENDINGOtherMHN-MANAGED HEALTH NETWORK
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY