Provider Demographics
NPI:1598491896
Name:SCHRAUBEN, SAMANTHA JEAN (LLMSW)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:JEAN
Last Name:SCHRAUBEN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N WEST AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2174
Mailing Address - Country:US
Mailing Address - Phone:517-789-1234
Mailing Address - Fax:517-784-7040
Practice Address - Street 1:1200 N WEST AVE STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2174
Practice Address - Country:US
Practice Address - Phone:517-789-1234
Practice Address - Fax:517-784-7040
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511153661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical