Provider Demographics
NPI:1629251087
Name:SAMAROO, AMBER THANI (PH D, LCSW)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:THANI
Last Name:SAMAROO
Suffix:
Gender:M
Credentials:PH D, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N HADDON AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1753
Mailing Address - Country:US
Mailing Address - Phone:856-354-8525
Mailing Address - Fax:856-354-0830
Practice Address - Street 1:501 N HADDON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1753
Practice Address - Country:US
Practice Address - Phone:856-354-8525
Practice Address - Fax:856-354-0830
Is Sole Proprietor?:No
Enumeration Date:2007-12-08
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC013702001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC-163443Medicare UPIN