Provider Demographics
NPI:1245717271
Name:KERN, SAMANTHA (LMSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KERN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:CAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1785 W STADIUM BLVD STE 203C
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5291
Mailing Address - Country:US
Mailing Address - Phone:734-913-1093
Mailing Address - Fax:734-369-2683
Practice Address - Street 1:1785 W STADIUM BLVD STE 203C
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5291
Practice Address - Country:US
Practice Address - Phone:734-913-1093
Practice Address - Fax:734-369-2683
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011029491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical