Provider Demographics
NPI:1962043430
Name:POYTA, SAMANTHA F
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:F
Last Name:POYTA
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 1:19222 11TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-2241
Mailing Address - Country:US
Mailing Address - Phone:571-377-9384
Mailing Address - Fax:
Practice Address - Street 1:19222 11TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-2241
Practice Address - Country:US
Practice Address - Phone:571-377-9384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker