Provider Demographics
NPI:1962980888
Name:BROCKMEYER, SAMANTHA J (MSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:BROCKMEYER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JO
Other - Last Name:BROCKMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:11905 HASTINGS RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-4341
Mailing Address - Country:US
Mailing Address - Phone:216-412-1381
Mailing Address - Fax:
Practice Address - Street 1:1 BEREA CMNS STE 200
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-2534
Practice Address - Country:US
Practice Address - Phone:216-418-7397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHI.25074291041C0700X
OHCDCA.169590101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)