Provider Demographics
NPI:1891417929
Name:EVLOGIMENOS, SAMANTHA ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ANN
Last Name:EVLOGIMENOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 SW 98TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-6705
Mailing Address - Country:US
Mailing Address - Phone:305-546-8063
Mailing Address - Fax:
Practice Address - Street 1:950 N KROME AVE STE 401
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4443
Practice Address - Country:US
Practice Address - Phone:305-248-0874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL177031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical