Provider Demographics
NPI:1205425014
Name:MEADOWS, SAMANTHA BEEMAN (LCSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BEEMAN
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 MIAMI RD
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-5657
Mailing Address - Country:US
Mailing Address - Phone:765-228-8897
Mailing Address - Fax:
Practice Address - Street 1:2578 BROADWAY # 607
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5642
Practice Address - Country:US
Practice Address - Phone:212-284-7206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011137751041C0700X
IN34008236A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical