Provider Demographics
NPI:1710432703
Name:GINSBURG, SAMANTHA ANN (MS, IMH13697)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:GINSBURG
Suffix:
Gender:F
Credentials:MS, IMH13697
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11730 CRANBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5756
Mailing Address - Country:US
Mailing Address - Phone:772-643-4023
Mailing Address - Fax:
Practice Address - Street 1:5728 MAJOR BLVD
Practice Address - Street 2:SUITE 506
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7945
Practice Address - Country:US
Practice Address - Phone:772-643-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH13697101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health