Provider Demographics
NPI:1619562188
Name:INZANA, SAMANTHA JO (LSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:INZANA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JO
Other - Last Name:LECHENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:434 KEPPLE RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL POINT
Mailing Address - State:PA
Mailing Address - Zip Code:15942-4604
Mailing Address - Country:US
Mailing Address - Phone:814-215-7050
Mailing Address - Fax:
Practice Address - Street 1:303 BUDFIELD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3213
Practice Address - Country:US
Practice Address - Phone:814-266-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137538104100000X
PACW0232341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker