Provider Demographics
NPI:1992363113
Name:MCCARL, SAMANTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MCCARL
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 1:301 CALLE MOLINO
Mailing Address - Street 2:
Mailing Address - City:PACHECO
Mailing Address - State:CA
Mailing Address - Zip Code:94553-5262
Mailing Address - Country:US
Mailing Address - Phone:925-917-1439
Mailing Address - Fax:
Practice Address - Street 1:301 CALLE MOLINO
Practice Address - Street 2:
Practice Address - City:PACHECO
Practice Address - State:CA
Practice Address - Zip Code:94553-5262
Practice Address - Country:US
Practice Address - Phone:925-917-1439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-47599103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst