Provider Demographics
NPI:1710486402
Name:BATEMAN, SAMANTHA LYNN
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LYNN
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 W RAY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-8537
Mailing Address - Country:US
Mailing Address - Phone:602-535-8341
Mailing Address - Fax:480-812-4831
Practice Address - Street 1:82 W RAY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-8537
Practice Address - Country:US
Practice Address - Phone:602-535-8341
Practice Address - Fax:480-812-4831
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-17-42491106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician