Provider Demographics
NPI:1922726678
Name:EARL, SAMANTHA ANN
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:ANN
Last Name:EARL
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 1:305 MADISON ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-1938
Mailing Address - Country:US
Mailing Address - Phone:862-202-9275
Mailing Address - Fax:
Practice Address - Street 1:305 MADISON ST APT 2R
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-1938
Practice Address - Country:US
Practice Address - Phone:862-202-9275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst