Provider Demographics
NPI:1912181801
Name:TOMA, SAMANTHA AILEEN
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:AILEEN
Last Name:TOMA
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 1:8010 GRAND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9303
Mailing Address - Country:US
Mailing Address - Phone:518-256-3986
Mailing Address - Fax:
Practice Address - Street 1:8010 GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9303
Practice Address - Country:US
Practice Address - Phone:518-256-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical