Provider Demographics
NPI:1619291465
Name:FULD, SAMANTHA JANE GORDON (LCSW-C)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JANE GORDON
Last Name:FULD
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 1:1238 TOWSON ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5326
Mailing Address - Country:US
Mailing Address - Phone:989-751-1087
Mailing Address - Fax:
Practice Address - Street 1:1238 TOWSON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5326
Practice Address - Country:US
Practice Address - Phone:989-751-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0815461041C0700X
MD223681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical