Provider Demographics
NPI:1740341643
Name:ERICSON, SAMANTHA (MA)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:ERICSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 GALA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34291-4929
Mailing Address - Country:US
Mailing Address - Phone:941-374-0198
Mailing Address - Fax:
Practice Address - Street 1:2903 EDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6508
Practice Address - Country:US
Practice Address - Phone:941-374-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health