Provider Demographics
NPI:1609553056
Name:BLAUSTEIN, SAMANTHA (ACSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BLAUSTEIN
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5556 BILL CODY RD
Mailing Address - Street 2:
Mailing Address - City:HIDDEN HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1101
Mailing Address - Country:US
Mailing Address - Phone:818-661-0713
Mailing Address - Fax:
Practice Address - Street 1:24903 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4734
Practice Address - Country:US
Practice Address - Phone:310-310-9249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1153241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical