Provider Demographics
NPI:1184069726
Name:NEWMAN, SAMANTHA (M ED, BCBA)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:M ED, BCBA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAMANTHA FOWLER
Mailing Address - Street 1:2 DUCK POND RD APT 119
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-7105
Mailing Address - Country:US
Mailing Address - Phone:914-500-3351
Mailing Address - Fax:
Practice Address - Street 1:2 DUCK POND RD APT 119
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-7105
Practice Address - Country:US
Practice Address - Phone:914-500-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11621818103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst