Provider Demographics
NPI:1013502566
Name:HEENAN, SAMANTHA LEE (CPST, CPES, SBDD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEE
Last Name:HEENAN
Suffix:
Gender:F
Credentials:CPST, CPES, SBDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-5118
Mailing Address - Country:US
Mailing Address - Phone:203-306-8165
Mailing Address - Fax:
Practice Address - Street 1:102 2ND AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-5118
Practice Address - Country:US
Practice Address - Phone:203-306-8165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula