Provider Demographics
NPI:1801223136
Name:BARR, SAMANTHA A (LICSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:BARR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 OMAHA AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6330
Mailing Address - Country:US
Mailing Address - Phone:651-439-2446
Mailing Address - Fax:651-439-2071
Practice Address - Street 1:5850 OMAHA AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6330
Practice Address - Country:US
Practice Address - Phone:651-439-2446
Practice Address - Fax:651-439-2071
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN198801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical