Provider Demographics
NPI:1245883644
Name:ABERNATHY, SAMANTHA
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:LYNN
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3280 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1925
Mailing Address - Country:US
Mailing Address - Phone:907-209-0451
Mailing Address - Fax:
Practice Address - Street 1:416 HARRIS ST STE 228
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1079
Practice Address - Country:US
Practice Address - Phone:907-209-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical